=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578349528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINETIC CARE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2023
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 BAKERS CREEK RD
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28714-8441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-208-3737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 BAKERS CREEK RD
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28714-8441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER/OWNER
-----------------------------------------------------
Name | COURTNEY H BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-208-3737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------