Healthcare Provider Details

I. General information

NPI: 1902136773
Provider Name (Legal Business Name): ANGEL CARE KIDS THERAPY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 MAIN ST
HAVERHILL MA
01830-2011
US

IV. Provider business mailing address

969 MAIN ST
HAVERHILL MA
01830-2011
US

V. Phone/Fax

Practice location:
  • Phone: 978-521-6150
  • Fax: 978-521-2659
Mailing address:
  • Phone: 978-521-6150
  • Fax: 978-521-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8830
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY COOK
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: O.T.
Phone: 978-521-6150