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General NPI Number Information
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NPI Number | 1285465898
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Entity Type | Organization
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Legal Business Name | DINOMITE KIDS PEDIATRIC THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 1800 MORMON MILL RD STE A2
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City | MARBLE FALLS
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State | TX
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Zip | 78654-4176
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Country | US
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Telephone | 210-982-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 332 MAIN ST
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City | BERTRAM
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State | TX
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Zip | 78605-4414
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Country | US
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Telephone | 210-982-2802
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Fax |
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Authorized Official
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Title or Position | CEO; SLP
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Name | MS. EVA KATHLEEN SAREM
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Credential | SLP
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Telephone | 210-982-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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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 |
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License Number State |
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