Organization
CANYON KIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ROBERT HISCOCK (BUSINESS MANAGER)
(301) 257-7387
Entity
Organization
Contact information
Practice address
4833 RUGBY AVE STE 500, BETHESDA, MD 20814-3910
(301) 523-0902
(240) 244-0079
Mailing address
4833 RUGBY AVE STE 500, BETHESDA, MD 20814-3910
(301) 257-7387
(240) 244-0079
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
02/04/2014
Last updated
08/26/2024
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