Healthcare Provider Details

I. General information

NPI: 1205757739
Provider Name (Legal Business Name): GENTLE TABLE PEDIATRIC THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19161 W HAZELWOOD ST
LITCHFIELD PARK AZ
85340-4743
US

IV. Provider business mailing address

19161 W HAZELWOOD ST
LITCHFIELD PARK AZ
85340-4743
US

V. Phone/Fax

Practice location:
  • Phone: 480-450-0932
  • Fax:
Mailing address:
  • Phone: 480-450-0932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY OCHOA
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: MS, OTR/L
Phone: 480-450-0932