Provider Demographics
NPI:1407166192
Name:CHILDREN'S THERAPY INNOVATIONS INC.
Entity type:Organization
Organization Name:CHILDREN'S THERAPY INNOVATIONS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:OTIATO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:574-387-4049
Mailing Address - Street 1:2012 IRONWOOD CIR STE 230
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1889
Mailing Address - Country:US
Mailing Address - Phone:574-387-4049
Mailing Address - Fax:574-387-4062
Practice Address - Street 1:2012 IRONWOOD CIR STE 230
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1889
Practice Address - Country:US
Practice Address - Phone:574-387-4049
Practice Address - Fax:574-387-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X, 315P00000X, 320600000X, 320900000X, 252Y00000X
IN253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No252Y00000XAgenciesEarly Intervention Provider Agency
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201131520AMedicaid
IN201234930AMedicaid