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General NPI Number Information
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NPI Number | 1740871698
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Entity Type | Organization
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Legal Business Name | KIDS THERAPY 4 SUCCESS
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 118 N CHURCH ST
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City | LODI
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State | CA
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Zip | 95240-2103
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Country | US
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Telephone | 209-443-4244
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 621
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City | WOODBRIDGE
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State | CA
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Zip | 95258-0621
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Country | US
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Telephone | 209-327-3309
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERPIST/PARTNER
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Name | SHELLEY BANKS
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Credential | OTR/L
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Telephone | 209-327-3309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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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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