Healthcare Provider Details

I. General information

NPI: 1861425126
Provider Name (Legal Business Name): O. T. 4 KIDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 NE 10TH AVE
CRYSTAL RIVER FL
34429-4456
US

IV. Provider business mailing address

335 NE 10TH AVE
CRYSTAL RIVER FL
34429-4456
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-5552
  • Fax: 352-795-7751
Mailing address:
  • Phone: 352-795-5552
  • Fax: 352-795-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHONDA VANQUELEF
Title or Position: OWNER
Credential:
Phone: 352-795-5552