Healthcare Provider Details

I. General information

NPI: 1508183443
Provider Name (Legal Business Name): KIDS IN BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N GORDON PL
MILWAUKEE WI
53212-3018
US

IV. Provider business mailing address

2555 N GORDON PL
MILWAUKEE WI
53212-3018
US

V. Phone/Fax

Practice location:
  • Phone: 414-378-5303
  • Fax: 414-376-5552
Mailing address:
  • Phone: 414-378-5303
  • Fax: 414-376-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number056006553
License Number StateIL

VIII. Authorized Official

Name: MS. DEBRA ANN D'AMICO SCHMITZ
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT,OTR/L
Phone: 414-378-5303