Healthcare Provider Details

I. General information

NPI: 1023739786
Provider Name (Legal Business Name): CONFIDENT KIND INCLUSIVE DEVELOPMENT ZONE PT AND OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15801 CROSSBAY BLVD
HOWARD BEACH NY
11414-3140
US

IV. Provider business mailing address

15801 CROSSBAY BLVD
HOWARD BEACH NY
11414-3140
US

V. Phone/Fax

Practice location:
  • Phone: 718-848-0875
  • Fax:
Mailing address:
  • Phone: 718-848-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER HURLEY- COOK
Title or Position: DIRECTOR/OWNER
Credential: PT
Phone: 718-848-0875