Provider Demographics
NPI:1871008268
Name:CHILDREN'S THERAPY CENTER
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY-BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAULHARDT-MEYRING
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:805-383-1501
Mailing Address - Street 1:155 GRANADA ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7725
Mailing Address - Country:US
Mailing Address - Phone:805-383-1501
Mailing Address - Fax:
Practice Address - Street 1:155 GRANADA ST STE A
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7725
Practice Address - Country:US
Practice Address - Phone:805-383-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3987225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty