Healthcare Provider Details

I. General information

NPI: 1477711299
Provider Name (Legal Business Name): KRATU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16036 N 11TH AVE UNIT 1025
PHOENIX AZ
85023
US

IV. Provider business mailing address

PO BOX 88035
PHOENIX AZ
85080-8035
US

V. Phone/Fax

Practice location:
  • Phone: 480-636-0589
  • Fax: 888-351-6583
Mailing address:
  • Phone: 480-636-0589
  • Fax: 888-351-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number3485
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number3485
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number3485
License Number StateAZ

VIII. Authorized Official

Name: KAVITA PARIKH
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR L ATP
Phone: 480-636-0589