Healthcare Provider Details

I. General information

NPI: 1356764567
Provider Name (Legal Business Name): KID FUNCTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 THOMAS POINT ROAD
BRUNSWICK ME
04011
US

IV. Provider business mailing address

225 THOMAS POINT ROAD
BRUNSWICK ME
04011
US

V. Phone/Fax

Practice location:
  • Phone: 603-748-0013
  • Fax:
Mailing address:
  • Phone: 603-748-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA D. BREWSTER-TAYLOR
Title or Position: OWNER
Credential: PT
Phone: 603-748-0013