Healthcare Provider Details

I. General information

NPI: 1891414843
Provider Name (Legal Business Name): BEACHES CONFIDENT KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 BEACH BLVD
JACKSONVILLE BEACH FL
32250-3445
US

IV. Provider business mailing address

1157 BEACH BLVD
JACKSONVILLE BEACH FL
32250-3445
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-7560
  • Fax: 904-490-9034
Mailing address:
  • Phone: 904-325-7560
  • Fax: 904-490-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTI HINCKLEY
Title or Position: OWNER
Credential: OTR/L
Phone: 904-566-1287