MEDICARE: KIDS QUALITY THERAPY INC.

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
1	225XP0200X	Pediatric Occupational Therapist	OT13788	FL
2	225200000X	Physical Therapy Assistant	PTA24257	FL
3	235Z00000X	Speech-Language Pathologist	SA12054	FL
4	2251P0200X	Pediatric Physical Therapist	PT26138	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1538428446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS QUALITY THERAPY INC.

Provider Business Mailing Address
First Line	:	1550 W 84TH ST
Second Line	:	SUITE 58
City	:	HIALEAH
State	:	FL
Zip	:	33014-3377
Country	:	US
Telephone Number	:	305-985-6122
Fax Number	:	786-545-7657

Provider Business Practice Location Address
First Line	:	1550 W 84TH ST
Second Line	:	SUITE 58
City	:	HIALEAH
State	:	FL
Zip	:	33014-3377
Country	:	US
Telephone Number	:	305-985-6122
Fax Number	:	786-545-7657

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	DR. JESSIELYNN AVILA
Credential	:	DPT
Telephone Number	:	305-985-6122

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	03/21/2016

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Practice Location Address:

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Directions to “KIDS QUALITY THERAPY INC. ” Practice Location

Language	Start Address	Practice Location

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