Provider Demographics
NPI:1881856292
Name:CHILDREN THERAPY STUDIO
Entity Type:Organization
Organization Name:CHILDREN THERAPY STUDIO
Other - Org Name:PEDIATRIC THERAPY SOLUTIONS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:949-355-6111
Mailing Address - Street 1:1451 QUAIL STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2742
Mailing Address - Country:US
Mailing Address - Phone:949-355-6111
Mailing Address - Fax:
Practice Address - Street 1:1451 QUAIL ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2742
Practice Address - Country:US
Practice Address - Phone:949-355-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3097261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities