Healthcare Provider Details

I. General information

NPI: 1396085718
Provider Name (Legal Business Name): KIDS ON THE MOVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W 260 N
OREM UT
84057-1970
US

IV. Provider business mailing address

475 W 260 N
OREM UT
84057-1970
US

V. Phone/Fax

Practice location:
  • Phone: 801-221-9930
  • Fax: 801-221-0649
Mailing address:
  • Phone: 801-221-9930
  • Fax: 801-221-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. EILEEN CHAMBERLAND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-221-9930