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General NPI Number Information
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NPI Number | 1538428446
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Entity Type | Organization
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Legal Business Name | KIDS QUALITY THERAPY INC.
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 1550 W 84TH ST SUITE 58
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City | HIALEAH
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State | FL
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Zip | 33014-3377
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Country | US
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Telephone | 305-985-6122
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Fax | 786-545-7657
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Provider Business Mailing Address
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Address Line | 1550 W 84TH ST SUITE 58
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City | HIALEAH
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State | FL
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Zip | 33014-3377
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Country | US
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Telephone | 305-985-6122
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Fax | 786-545-7657
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. JESSIELYNN AVILA
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Credential | DPT
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Telephone | 305-985-6122
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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 | OT13788
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA24257
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA12054
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT26138
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License Number State | FL
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