1629151311 NPI number — EDUCATIONAL AND DEVELOPMENTAL INTERVENTION SERVICES

Table of content: (NPI 1629151311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629151311 NPI number — EDUCATIONAL AND DEVELOPMENTAL INTERVENTION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDUCATIONAL AND DEVELOPMENTAL INTERVENTION SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629151311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235TH BSB BOX 215 CMR 463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09177-9177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
1-468-7644
Provider Business Mailing Address Fax Number:
1-468-7853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235TH BSB BOX 215 CMR 463 09177
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09177-8614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
011499811837644
Provider Business Practice Location Address Fax Number:
001499811838753
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
MADELYN
Authorized Official Middle Name:
PRISCILLA
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
409-468-7811

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X , with the licence number:  5201006825 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com