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General NPI Number Information
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NPI Number | 1871034132
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Entity Type | Organization
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Legal Business Name | KIDDOTHERAPY
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 1054 WAR BONNET WAY
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-9216
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Country | US
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Telephone | 513-309-3905
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Fax | 650-560-2530
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Provider Business Mailing Address
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Address Line | 1054 WAR BONNET WAY
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-9216
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Country | US
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Telephone | 513-309-3905
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Fax | 650-560-2530
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Authorized Official
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Title or Position | PRESIDENT
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Name | COURTNEY CARSMAN
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Credential | MOTRL
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Telephone | 513-309-3905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 08-0049
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License Number State | NV
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