NPIMap

Organization Active NPI

Children'S Service Center of Wyoming Valley, Inc

  • Occupational Therapist
  • Wilkes Barre, PA
National Provider Identifier
1649060955
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY, INC
Practice address
110 S Pennsylvania Ave
Wilkes Barre, PA 18701-3301
Phone
(570) 825-6425
NPI assigned
May 9, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Boyle
Title
Ceo
Phone
(570) 825-6425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

110 S Pennsylvania Ave
Wilkes Barre, PA 18701-3301

Mailing address

335 S Franklin St
Wilkes Barre, PA 18702-3808
Phone (570) 825-6425

Other practice location 1

335 S Franklin St
Wilkes Barre, PA 18702-3808
Phone (570) 825-6425

Other identifiers 1

IdentifierTypeStateIssuer
1007280110159MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170609001473 PA Part B Supplier - Clinic/Group Practice 1052567617 Receives reassigned benefits from 51 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Honesdale, PA; Tunkhannock, PA; Wilkes Barre, PA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Childrens Service Ctr13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1649060955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 S FRANKLIN ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023808",
            "telephone_number": "570-825-6425",
            "fax_number": "570-762-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S PENNSYLVANIA AVE",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187013301",
            "telephone_number": "570-825-6425"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 S Franklin St",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187023808",
            "country_code": "US",
            "telephone_number": "570-825-6425",
            "fax_number": "570-762-9011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDREN'S SERVICE CENTER OF WYOMING VALLEY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-09",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A",
        "authorized_official_last_name": "BOYLE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-825-6425"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007280110159",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.