Provider Demographics
NPI:1922480334
Name:CHILDREN'S THERAPY CENTER
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CENTER
Other - Org Name:DYNAMIC FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-854-7025
Mailing Address - Street 1:10811 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7108
Mailing Address - Country:US
Mailing Address - Phone:253-854-5660
Mailing Address - Fax:253-854-7025
Practice Address - Street 1:127 SW 156TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2562
Practice Address - Country:US
Practice Address - Phone:253-216-0720
Practice Address - Fax:253-216-0906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S THERAPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-22
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies