Healthcare Provider Details

I. General information

NPI: 1164330965
Provider Name (Legal Business Name): KIDKINETICS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 MARNAT RD
BALTIMORE MD
21208-4508
US

IV. Provider business mailing address

3317 MARNAT RD
BALTIMORE MD
21208-4508
US

V. Phone/Fax

Practice location:
  • Phone: 347-782-9807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: AVIGAIL KHAVER
Title or Position: MS OTR/L
Credential:
Phone: 347-782-9807