Provider Demographics
NPI:1659512036
Name:BUILDING BLOCKS PEDIATRIC THERAPY INC.
Entity Type:Organization
Organization Name:BUILDING BLOCKS PEDIATRIC THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-216-3410
Mailing Address - Street 1:4 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-2149
Mailing Address - Country:US
Mailing Address - Phone:207-216-3410
Mailing Address - Fax:207-384-5845
Practice Address - Street 1:4 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-2149
Practice Address - Country:US
Practice Address - Phone:207-216-3410
Practice Address - Fax:207-384-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME172880000Medicaid
0470761OtherCIGNA