Healthcare Provider Details

I. General information

NPI: 1255277513
Provider Name (Legal Business Name): KIDS CLUB THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 NW 85TH AVE APT 407
DORAL FL
33166-5346
US

IV. Provider business mailing address

5300 NW 85TH AVE APT 407
DORAL FL
33166-5346
US

V. Phone/Fax

Practice location:
  • Phone: 413-285-0361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAYRIM LOPEZ
Title or Position: OWNER
Credential: SLP
Phone: 413-285-0361