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General NPI Number Information
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NPI Number | 1154693364
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Entity Type | Organization
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Legal Business Name | KALEIDOSCOPE PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 7211 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0926
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Country | US
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Telephone | 208-375-4200
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Fax | 208-375-4201
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Provider Business Mailing Address
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Address Line | 7211 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0926
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Country | US
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Telephone | 208-375-4200
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Fax | 208-375-4201
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATIE ROWE
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Credential | PT, DPT
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Telephone | 208-375-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1860
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP-1992
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-709
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License Number State | ID
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