Provider Demographics
NPI:1366598310
Name:PROJECT CHILLD LLC
Entity type:Organization
Organization Name:PROJECT CHILLD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR L
Authorized Official - Phone:978-232-0332
Mailing Address - Street 1:500 CUMMINGS CTR
Mailing Address - Street 2:SUITE 3850
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6142
Mailing Address - Country:US
Mailing Address - Phone:978-232-0332
Mailing Address - Fax:978-232-1103
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:SUITE 3850
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6142
Practice Address - Country:US
Practice Address - Phone:978-232-0332
Practice Address - Fax:978-232-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOG0033OtherBLUE CROSS BLUE SHIELD