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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