Healthcare Provider Details

I. General information

NPI: 1275731242
Provider Name (Legal Business Name): OT 4 KIDZ, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 14TH ST UNIT B
SANTA MONICA CA
90404-7028
US

IV. Provider business mailing address

1932 14TH ST UNIT B
SANTA MONICA CA
90404-4605
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-2276
  • Fax:
Mailing address:
  • Phone: 310-344-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2077
License Number StateCA

VIII. Authorized Official

Name: KARI THOMPSON
Title or Position: PEDIATRIC OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L, BCP
Phone: 310-344-2276