Healthcare Provider Details

I. General information

NPI: 1477348407
Provider Name (Legal Business Name): EXTRAORDINARY KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N LITCHFIELD RD STE 185
GOODYEAR AZ
85338-1369
US

IV. Provider business mailing address

250 N LITCHFIELD RD STE 185
GOODYEAR AZ
85338-1369
US

V. Phone/Fax

Practice location:
  • Phone: 480-875-8450
  • Fax: 623-303-1020
Mailing address:
  • Phone: 480-875-8450
  • Fax: 623-303-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: EJ SNETSKY
Title or Position: OWNER
Credential:
Phone: 480-875-8450