MEDICARE: HIGH 5 KIDS THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1437715356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH 5 KIDS THERAPY INC

Provider Business Mailing Address
First Line	:	754 CRESCENT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4546
Country	:	US
Telephone Number	:	917-574-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	754 CRESCENT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4546
Country	:	US
Telephone Number	:	917-574-1314
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRICIA ANDERSON
Credential	:
Telephone Number	:	917-574-1314

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

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