Organization
BAYSIDE CHILDREN'S THERAPY NETWORK, INC.
Active
Organization
BAYSIDE CHILDREN'S THERAPY NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MCCANN MA, OTR (PRESIDENT, OT)
(804) 210-1555
Entity
Organization
Contact information
Practice address
6688 MAIN ST, GLOUCESTER, VA 23061-5194
(804) 210-1555
Mailing address
PO BOX 130, GLOUCESTER, VA 23061-0130
(804) 210-1555
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
2305000705
VA
225XP0200X
Pediatric Occupational Therapist
Primary
0119004244
VA
235Z00000X
Speech-Language Pathologist
2202003940
VA
Other
Enumeration date
08/03/2010
Last updated
09/09/2010
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