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NPI Code Detail

MEDICARE: KID FUNDAMENTALS THERAPY CENTER, INC.

MEDICARE: KID FUNDAMENTALS THERAPY CENTER, 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
1225XP0200XPediatric Occupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11770874299OTHERCANPI TYPE 1

General Provider Information

NPI Number : 1518529635
Entity Type Code : Organization
Provider Name (Legal Business Name) : KID FUNDAMENTALS THERAPY CENTER, INC.
Provider Business Mailing Address
First Line : PO BOX 1726
Second Line :
City : WESTMINSTER
State : CA
Zip : 92684-1726
Country : US
Telephone Number : 714-750-9700
Fax Number :
Provider Business Practice Location Address
First Line : 12900B GARDEN GROVE BLVD STE 235
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92843-2027
Country : US
Telephone Number : 714-750-9700
Fax Number : 714-750-9797
Authorized Official
Title or Position : PRESIDENT
Name : LESLIE C. VALMONTE
Credential : M.A., OTR/L
Telephone Number : 714-750-9700
Provider Enumeration Date : 06/29/2019
Last Update Date : 11/22/2021

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1770874299 — LESLIE C. VALMONTE M.A., OTR/L
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Practice Location Address:
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Directions to “KID FUNDAMENTALS THERAPY CENTER, INC. ” Practice Location

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