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General NPI Number Information
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NPI Number | 1578041398
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Entity Type | Organization
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Legal Business Name | CHILDREN'S SPOT 4 THERAPY, LLC
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 2300 E RANCIER AVE STE 106
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City | KILLEEN
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State | TX
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Zip | 76543-3450
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Country | US
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Telephone | 254-781-3447
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Fax | 254-227-6163
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Provider Business Mailing Address
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Address Line | 1121 WESTWAY DR
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City | TEMPLE
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State | TX
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Zip | 76502-5151
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Country | US
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Telephone | 361-523-1049
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. JESSICA CLICKENER
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Credential | OTR
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Telephone | 254-781-3447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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