Organization
BLAST OFF CHILDREN'S THERAPY SERVICES, INC.
Active
Organization
BLAST OFF CHILDREN'S THERAPY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUANN H. LOWER MA, CCC-SLP (PRESIDENT, CEO)
(858) 866-8133
Entity
Organization
Contact information
Practice address
9520 PADGETT ST, SUITE 104, SAN DIEGO, CA 92126-4445
(858) 866-8133
(858) 999-2002
Mailing address
9520 PADGETT ST, SUITE 104, SAN DIEGO, CA 92126-4445
(858) 866-8133
(858) 999-2002
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
13795
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13795
SLP LICENSE
CA
Enumeration date
08/13/2013
Last updated
08/13/2013
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