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General NPI Number Information
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NPI Number | 1538707799
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Entity Type | Organization
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Legal Business Name | KID SPOT
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 9 PINE CONE DR STE 104A
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City | PALM COAST
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State | FL
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Zip | 32137-8683
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Country | US
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Telephone | 386-283-8316
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Fax |
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Provider Business Mailing Address
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Address Line | 35 RYDER DR
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City | PALM COAST
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State | FL
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Zip | 32164-6002
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Country | US
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Telephone | 386-283-8316
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK MEYER
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Credential | COTA
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Telephone | 386-283-8316
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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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