Provider Demographics
NPI:1154613495
Name:PEDIATRIC PATHWAYS INC
Entity type:Organization
Organization Name:PEDIATRIC PATHWAYS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CLERK
Authorized Official - Last Name:BELLIVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:408-778-6200
Mailing Address - Street 1:17400 MONTEREY RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7319
Mailing Address - Country:US
Mailing Address - Phone:408-778-6200
Mailing Address - Fax:408-484-1096
Practice Address - Street 1:17400 MONTEREY RD STE 2E
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7319
Practice Address - Country:US
Practice Address - Phone:408-778-6200
Practice Address - Fax:408-484-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4831225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty