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General NPI Number Information
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NPI Number | 1467574723
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Entity Type | Organization
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Legal Business Name | KIDPRO THERAPIES, INC
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 10702 SW ELSINORE DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-2149
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Country | US
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Telephone | 772-260-9499
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Fax |
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Provider Business Mailing Address
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Address Line | 8651 SW CRUDEN BAY CT
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City | STUART
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State | FL
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Zip | 34997-4206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JENNIFER L WILD
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Credential | OTR
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Telephone | 772-260-9499
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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 |
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License Number State |
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