Provider Demographics
NPI:1205297785
Name:SKYCLIMB SENSORY DEVELOPMENT CENTER
Entity type:Organization
Organization Name:SKYCLIMB SENSORY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERIN
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:FETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:540-773-4436
Mailing Address - Street 1:2400 VALLEY AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2765
Mailing Address - Country:US
Mailing Address - Phone:540-773-4436
Mailing Address - Fax:540-773-4434
Practice Address - Street 1:2400 VALLEY AVE STE 9
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2765
Practice Address - Country:US
Practice Address - Phone:540-773-4436
Practice Address - Fax:540-773-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty