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General NPI Number Information
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NPI Number | 1922883453
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Entity Type | Organization
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Legal Business Name | KIDABLE THERAPY
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 4335 BRAMBLETON AVE
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City | ROANOKE
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State | VA
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Zip | 24018-3404
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Country | US
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Telephone | 540-315-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 4335 BRAMBLETON AVE
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City | ROANOKE
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State | VA
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Zip | 24018-3404
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Country | US
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Telephone | 540-315-3266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAUREN VISTARAKULA
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Credential | OTD, OTR/L
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Telephone | 540-315-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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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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