Provider Demographics
NPI:1598892739
Name:THERAPY UNLIMITED-CHILDREN'S THERAPY CENTER
Entity type:Organization
Organization Name:THERAPY UNLIMITED-CHILDREN'S THERAPY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISIGO-WICKLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-945-3012
Mailing Address - Street 1:P.O BOX 425
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-0425
Mailing Address - Country:US
Mailing Address - Phone:860-945-3012
Mailing Address - Fax:860-945-9854
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06779-1999
Practice Address - Country:US
Practice Address - Phone:860-945-3012
Practice Address - Fax:860-945-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
133V00000X, 225100000X, 225X00000X, 235Z00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186111Medicaid