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General NPI Number Information
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NPI Number | 1649378951
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Entity Type | Organization
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Legal Business Name | OT KIDZ STYLE, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2131 MCDOWELL ST
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City | AUGUSTA
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State | GA
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Zip | 30904-4490
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Country | US
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Telephone | 706-339-4026
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 MCDOWELL ST
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City | AUGUSTA
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State | GA
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Zip | 30904-4490
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Country | US
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Telephone | 706-339-4026
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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 | REGINA RAY
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Credential |
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Telephone | 706-339-4026
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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 | OT001615
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License Number State | GA
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