Provider Demographics
NPI:1316451263
Name:PEDIATRIC FEEDING SERVICES, INC.
Entity type:Organization
Organization Name:PEDIATRIC FEEDING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:804-691-4526
Mailing Address - Street 1:2224 LOCH BRAEMAR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1611
Mailing Address - Country:US
Mailing Address - Phone:804-691-4526
Mailing Address - Fax:
Practice Address - Street 1:2224 LOCH BRAEMAR DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1611
Practice Address - Country:US
Practice Address - Phone:804-691-4526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Single Specialty