Healthcare Provider Details

I. General information

NPI: 1942515481
Provider Name (Legal Business Name): KINDER KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 MILLBROOK AVE SUITE 8
AIKEN SC
29803-0603
US

IV. Provider business mailing address

958 MILLBROOK AVE SUITE 8
AIKEN SC
29803-0603
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0131
  • Fax: 803-642-2665
Mailing address:
  • Phone: 803-226-0131
  • Fax: 803-642-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KENNIETH DOUGLAS ALLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-226-0131