MEDICARE: KIDZ THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1164756672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDZ THERAPY, LLC

Provider Business Mailing Address
First Line	:	3508 FORT HILL DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-2105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 FORT HILL DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-2105
Country	:	US
Telephone Number	:	703-862-6557
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARY-KATHERINE DAVIDSON-TAYLOR
Credential	:	MS OTR/L
Telephone Number	:	703-862-6557

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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Directions to “KIDZ THERAPY, LLC ” Practice Location

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