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General NPI Number Information
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NPI Number | 1730329459
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Entity Type | Organization
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Legal Business Name | KIDTASTIC CONSULTING SERVICES, INC.
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Dates
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Enumeration Date | 02/21/2009
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Last Update Date | 02/21/2009
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Provider Practice Location Address
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Address Line | 62 BIRCH ST
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City | LAKE GROVE
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State | NY
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Zip | 11755-2743
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Country | US
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Telephone | 631-553-7952
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Fax |
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Provider Business Mailing Address
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Address Line | 62 BIRCH ST
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City | LAKE GROVE
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State | NY
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Zip | 11755-2743
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Country | US
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Telephone | 631-553-7952
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DAWNMARIE GARRETT
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Credential | MSED
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Telephone | 631-553-7952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 210765081
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License Number State | NY
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