Provider Demographics
NPI:1538419353
Name:ADDIE'S STUDIO ONE ON ONE, INC.
Entity type:Organization
Organization Name:ADDIE'S STUDIO ONE ON ONE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GODINHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-578-2232
Mailing Address - Street 1:7850 MISSION CENTER COURT #100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1322
Mailing Address - Country:US
Mailing Address - Phone:619-578-2232
Mailing Address - Fax:619-578-2231
Practice Address - Street 1:7850 MISSION CENTER COURT #100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1322
Practice Address - Country:US
Practice Address - Phone:619-578-2232
Practice Address - Fax:619-578-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty