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General NPI Number Information
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NPI Number | 1043918378
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Entity Type | Organization
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Legal Business Name | CONNECTED KIDS PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 20588 S ELLSWORTH LOOP RD APT 3125
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-0146
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Country | US
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Telephone | 602-341-3770
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Fax | 602-560-0504
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Provider Business Mailing Address
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Address Line | 20588 S ELLSWORTH LOOP RD APT 3125
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-0146
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Country | US
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Telephone | 602-341-3770
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Fax | 602-560-0504
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JACLYN PASTENA
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Credential | OTD, OTR/L
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Telephone | 23-413-7706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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