Provider Demographics
NPI:1639312929
Name:PEDIATRIC THERAPY NETWORK
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MOT
Authorized Official - Phone:310-328-0276
Mailing Address - Street 1:1815 W 213TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2800
Mailing Address - Country:US
Mailing Address - Phone:310-328-0276
Mailing Address - Fax:
Practice Address - Street 1:1815 W 213TH ST
Practice Address - Street 2:100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2800
Practice Address - Country:US
Practice Address - Phone:310-328-0276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8419251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management