Healthcare Provider Details

I. General information

NPI: 1578136495
Provider Name (Legal Business Name): KIDS CORNER THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7528 BIRDWOOD CT
NEW PORT RICHEY FL
34653-2102
US

IV. Provider business mailing address

7528 BIRDWOOD CT
NEW PORT RICHEY FL
34653-2102
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-4687
  • Fax:
Mailing address:
  • Phone: 304-629-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBIN LYNN JONES
Title or Position: OWNER/OT
Credential: OTR/L
Phone: 727-777-4687