Healthcare Provider Details

I. General information

NPI: 1366871808
Provider Name (Legal Business Name): KIDS CONNECTION DEVELOPMENTAL THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 09/11/2025
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 PARK CENTER DR STE D
SIMI VALLEY CA
93065-6200
US

IV. Provider business mailing address

160 W COCHRAN ST
SIMI VALLEY CA
93065-6215
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-3384
  • Fax: 800-513-8020
Mailing address:
  • Phone: 805-416-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT9265
License Number StateCA

VIII. Authorized Official

Name: CYNTHIA CONWAY
Title or Position: PRESIDENT
Credential: OT
Phone: 805-416-3384