Healthcare Provider Details

I. General information

NPI: 1497595821
Provider Name (Legal Business Name): CHILDRENS SPOT OF ALASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 KEPNER DR
ANCHORAGE AK
99504-3061
US

IV. Provider business mailing address

1803 KEPNER DR
ANCHORAGE AK
99504-3061
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-7457
  • Fax: 907-802-6149
Mailing address:
  • Phone: 907-854-7457
  • Fax: 907-802-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KELLY MAUREEN OTT
Title or Position: OCCUPATIONALTHERAPIST
Credential: OTD, OTR/L
Phone: 907-854-7457