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General NPI Number Information
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NPI Number | 1285884163
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Entity Type | Organization
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Legal Business Name | JUST FOR KIDS
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 11 MARTELE CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7615
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Country | US
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Telephone | 864-962-6832
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MARTELE CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7615
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Country | US
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Telephone | 864-962-6832
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANGELA NICOLE BOYD
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Credential | MSR, OTR/L
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Telephone | 864-962-6832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2578
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License Number State | SC
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