Provider Demographics
NPI:1710301007
Name:PEDIATRIC THERAPY OF SANTA CLARITA
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY OF SANTA CLARITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHLAGER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:661-254-1842
Mailing Address - Street 1:26639 VALLEY CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2357
Mailing Address - Country:US
Mailing Address - Phone:661-254-1842
Mailing Address - Fax:661-254-1862
Practice Address - Street 1:26639 VALLEY CENTER DR
Practice Address - Street 2:STE. 101
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-2357
Practice Address - Country:US
Practice Address - Phone:661-254-1842
Practice Address - Fax:661-254-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 102225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty