Provider Demographics
NPI:1912314691
Name:KIDS IN PROCESS DEVELOPMENTAL THERAPY
Entity Type:Organization
Organization Name:KIDS IN PROCESS DEVELOPMENTAL THERAPY
Other - Org Name:SHIRLYN R MALLEY, M.A., OTR L
Other - Org Type:Other Name
Authorized Official - Title/Position:PEDIATRIC OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR L
Authorized Official - Phone:559-737-3790
Mailing Address - Street 1:6347 W JUDY AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-0814
Mailing Address - Country:US
Mailing Address - Phone:559-737-3790
Mailing Address - Fax:559-735-0874
Practice Address - Street 1:6347 W JUDY AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-0814
Practice Address - Country:US
Practice Address - Phone:559-737-3790
Practice Address - Fax:559-735-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326115437Medicaid