Healthcare Provider Details

I. General information

NPI: 1255241212
Provider Name (Legal Business Name): KEY PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 VERMEER DR
NOKOMIS FL
34275-4464
US

IV. Provider business mailing address

1308 VERMEER DR
NOKOMIS FL
34275-4464
US

V. Phone/Fax

Practice location:
  • Phone: 941-993-2067
  • Fax:
Mailing address:
  • Phone: 941-993-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CIARA JOHNSON
Title or Position: OWNER/SPEECH LANGUAGE PATHOLOGIST
Credential: MS. CCC-SLP
Phone: 941-993-2067