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General NPI Number Information
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NPI Number | 1265094007
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Entity Type | Organization
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Legal Business Name | KID POWER, LLC
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 6125 GREEN BAY RD STE 800
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City | KENOSHA
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State | WI
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Zip | 53142-2982
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Country | US
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Telephone | 262-496-0289
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Fax |
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Provider Business Mailing Address
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Address Line | 6125 GREEN BAY RD STE 800
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City | KENOSHA
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State | WI
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Zip | 53142-2982
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Country | US
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Telephone | 262-496-0289
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | KACY PUNTILLO
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Credential | OTD, MS, OTR/L
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Telephone | 262-496-0289
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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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