=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023636735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OT KIDS PLUS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2020
-----------------------------------------------------
Last Update Date | 07/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 TUCKAHOE RD
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10710-5319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-319-6297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 206
-----------------------------------------------------
City | GOLDENS BRIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10526-0206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-319-6297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. HEATHER ANN MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-319-6297
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------