Provider Demographics
NPI:1801040746
Name:DEVELOPMENTAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COMER-PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:304-523-1164
Mailing Address - Street 1:845 4TH AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1428
Mailing Address - Country:US
Mailing Address - Phone:304-523-1164
Mailing Address - Fax:304-522-2474
Practice Address - Street 1:845 4TH AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1428
Practice Address - Country:US
Practice Address - Phone:304-523-1164
Practice Address - Fax:304-522-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP1168251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare