Healthcare Provider Details

I. General information

NPI: 1255635686
Provider Name (Legal Business Name): KIDS THERAPY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYSIDE RD STE 2
GREENLAND NH
03840-2117
US

IV. Provider business mailing address

1 BAYSIDE RD STE 2
GREENLAND NH
03840-2117
US

V. Phone/Fax

Practice location:
  • Phone: 603-373-0014
  • Fax: 603-433-6787
Mailing address:
  • Phone: 603-373-0014
  • Fax: 603-433-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number0857
License Number StateNH

VIII. Authorized Official

Name: LISA HERRHOLZ
Title or Position: OWNER
Credential: OTR/L
Phone: 603-373-0014