Healthcare Provider Details

I. General information

NPI: 1629199146
Provider Name (Legal Business Name): KIDSPOT THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SW 14TH ST
OCALA FL
34471-0615
US

IV. Provider business mailing address

425 SW 14TH ST
OCALA FL
34471-0615
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-8300
  • Fax: 352-351-8310
Mailing address:
  • Phone: 352-351-8300
  • Fax: 352-351-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-8330
License Number StateFL

VIII. Authorized Official

Name: LAUREL L BAXLA
Title or Position: OWNER-SOLE MEMBER
Credential: OTRL
Phone: 352-351-8300