Healthcare Provider Details

I. General information

NPI: 1790237758
Provider Name (Legal Business Name): KIDZONE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E YOUNG ST
HOWE TX
75459-4518
US

IV. Provider business mailing address

504 E YOUNG ST
HOWE TX
75459-4518
US

V. Phone/Fax

Practice location:
  • Phone: 903-744-4421
  • Fax:
Mailing address:
  • Phone: 903-744-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number212012
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number212012
License Number StateTX

VIII. Authorized Official

Name: MISS AMANDA ADAMS
Title or Position: OWNERTHERAPIST
Credential: COTA
Phone: 903-744-4421