Provider Demographics
NPI:1336477835
Name:CHILDREN'S THERAPY CLINIC INC
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-342-9515
Mailing Address - Street 1:PO BOX 2707
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25330-2707
Mailing Address - Country:US
Mailing Address - Phone:304-342-9515
Mailing Address - Fax:304-342-9414
Practice Address - Street 1:113 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1467
Practice Address - Country:US
Practice Address - Phone:304-342-9515
Practice Address - Fax:304-342-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable