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General NPI Number Information
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NPI Number | 1760579015
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Entity Type | Organization
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Legal Business Name | INNOVATIVE THERAPY 4 KIDS INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2333 STATE ST SUITE 201
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City | CARLSBAD
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State | CA
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Zip | 92008-1691
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Country | US
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Telephone | 760-434-3912
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Fax | 760-434-3871
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Provider Business Mailing Address
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Address Line | 2333 STATE ST SUITE 201
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City | CARLSBAD
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State | CA
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Zip | 92008-1691
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Country | US
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Telephone | 760-434-3912
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Fax | 760-434-3871
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Authorized Official
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Title or Position | ORAL MOTOR SPECIALIST DIRECTOR
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Name | MRS. LAURA JANE WALLS
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Credential | MS CCCSLP
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Telephone | 760-434-3912
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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 | SP9589
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | SP9589
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP9589
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | SP9589
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | SP9589
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License Number State | CA
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