Healthcare Provider Details

I. General information

NPI: 1154455616
Provider Name (Legal Business Name): KIDS ABILITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 HIGHWAY 96 W SUITE 300
SHOREVIEW MN
55126-1960
US

IV. Provider business mailing address

490 HIGHWAY 96 W SUITE 300
SHOREVIEW MN
55126-1960
US

V. Phone/Fax

Practice location:
  • Phone: 651-451-3016
  • Fax:
Mailing address:
  • Phone: 651-451-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER E. SARGENT
Title or Position: PRESIDENT
Credential: P.T.
Phone: 651-451-3016