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General NPI Number Information
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NPI Number | 1912272238
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Entity Type | Organization
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Legal Business Name | KIDDO'S REHAB 2, LLC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 05/28/2012
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Provider Practice Location Address
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Address Line | 524 S CLOSNER BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-4660
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Country | US
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Telephone | 956-380-4300
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Fax | 956-380-4361
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Provider Business Mailing Address
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Address Line | 524 S CLOSNER BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-4660
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Country | US
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Telephone | 956-380-4300
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Fax | 956-380-4361
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Authorized Official
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Title or Position | OWNER/ADMIN
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Name | MARIA G ROEL
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Credential | SLPA
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Telephone | 956-380-4300
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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 | 562550000
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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