Provider Demographics
NPI:1891147534
Name:THE PEDIATRIC DEVELOPMENT CENTER, LLC
Entity Type:Organization
Organization Name:THE PEDIATRIC DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHERILL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, COM
Authorized Official - Phone:301-869-7505
Mailing Address - Street 1:12520 PROSPERITY DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1664
Mailing Address - Country:US
Mailing Address - Phone:301-869-7505
Mailing Address - Fax:301-869-7515
Practice Address - Street 1:12520 PROSPERITY DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1664
Practice Address - Country:US
Practice Address - Phone:301-869-7505
Practice Address - Fax:301-869-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty