Healthcare Provider Details

I. General information

NPI: 1376438366
Provider Name (Legal Business Name): OT KID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5589 ANTONINUS DR
CINCINNATI OH
45238-1819
US

IV. Provider business mailing address

5589 ANTONINUS DR
CINCINNATI OH
45238-1819
US

V. Phone/Fax

Practice location:
  • Phone: 513-327-8585
  • Fax:
Mailing address:
  • Phone: 513-327-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARA SAMPSON
Title or Position: OWNER
Credential: OTD
Phone: 513-327-8585