Healthcare Provider Details

I. General information

NPI: 1700997863
Provider Name (Legal Business Name): KIDPOWER THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

IV. Provider business mailing address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4469
  • Fax:
Mailing address:
  • Phone: 505-888-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberFA0012834
License Number StateNM

VIII. Authorized Official

Name: MRS. CARLA CAY WILLIAMS
Title or Position: OWNER/DIRECTOR
Credential: OT/L
Phone: 505-888-4469