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NPI Code Detail

MEDICARE: KIDWORKS, LLC

MEDICARE: KIDWORKS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant32001204AIN
2225200000XPhysical Therapy Assistant06003228AIN
3225100000XPhysical Therapist05008714AIN
4235Z00000XSpeech-Language Pathologist22003689AIN
5225X00000XOccupational Therapist31003944AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033295472
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDWORKS, LLC
Provider Business Mailing Address
First Line : 1120 S CALUMET RD STE 3
Second Line :
City : CHESTERTON
State : IN
Zip : 46304-3286
Country : US
Telephone Number : 219-983-9675
Fax Number : 219-983-9681
Provider Business Practice Location Address
First Line : 1120 S CALUMET RD STE 3
Second Line :
City : CHESTERTON
State : IN
Zip : 46304-3286
Country : US
Telephone Number : 219-916-4960
Fax Number : 219-764-2751
Authorized Official
Title or Position : CEO
Name : CYNTHIA S MANGAN
Credential :
Telephone Number : 219-983-9675
Provider Enumeration Date : 10/27/2006
Last Update Date : 04/30/2008

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Directions to “KIDWORKS, LLC ” Practice Location

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