Provider Demographics
NPI:1932833399
Name:DYNAMIC CHILDREN'S THERAPY LLC
Entity Type:Organization
Organization Name:DYNAMIC CHILDREN'S THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-890-0480
Mailing Address - Street 1:650 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:ME
Mailing Address - Zip Code:04022-5646
Mailing Address - Country:US
Mailing Address - Phone:207-890-0480
Mailing Address - Fax:207-890-0480
Practice Address - Street 1:650 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:ME
Practice Address - Zip Code:04022-5646
Practice Address - Country:US
Practice Address - Phone:207-890-0480
Practice Address - Fax:207-890-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty