Healthcare Provider Details

I. General information

NPI: 1679802979
Provider Name (Legal Business Name): KIDVENTURES OCCUPATIONAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 BEE CAVE RD BLDG. L
WEST LAKE HILLS TX
78746-5245
US

IV. Provider business mailing address

5524 BEE CAVE RD BLDG. L
WEST LAKE HILLS TX
78746-5245
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-4499
  • Fax: 512-327-4495
Mailing address:
  • Phone: 512-327-4499
  • Fax: 512-327-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA R BALMER
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: OTR/L
Phone: 512-327-4499