Healthcare Provider Details

I. General information

NPI: 1407099542
Provider Name (Legal Business Name): KIDS IN MOTION THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 07/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 MANATEE AVE W
BRADENTON FL
34209-3952
US

IV. Provider business mailing address

4501 MANATEE AVE W
BRADENTON FL
34209-3952
US

V. Phone/Fax

Practice location:
  • Phone: 941-524-6773
  • Fax:
Mailing address:
  • Phone: 941-741-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 5137
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT 5137
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT 5137
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT 5137
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOT 5137
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT 5137
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT 5137
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 5137
License Number StateFL

VIII. Authorized Official

Name: MRS. GINA CHRISTINE PEREA
Title or Position: PRESIDENT/ OCCUPATIONAL THERAPIST
Credential: PEREA
Phone: 941-524-6773