Healthcare Provider Details

I. General information

NPI: 1598929259
Provider Name (Legal Business Name): KIDABILITIES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 HAMS WOODS LN
GREENVILLE NC
27858-8206
US

IV. Provider business mailing address

4077 HAMS WOODS LN
GREENVILLE NC
27858-8206
US

V. Phone/Fax

Practice location:
  • Phone: 252-916-5022
  • Fax:
Mailing address:
  • Phone: 252-916-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3600
License Number StateNC

VIII. Authorized Official

Name: MRS. KIMBERLY CHRISTINE NAY
Title or Position: SHAREHOLDER
Credential: OTR/L
Phone: 252-916-5022