MEDICARE: KID SPOT

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

General Provider Information

NPI Number	:	1538707799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KID SPOT

Provider Business Mailing Address
First Line	:	35 RYDER DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-6002
Country	:	US
Telephone Number	:	386-283-8316
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 PINE CONE DR STE 104A
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8683
Country	:	US
Telephone Number	:	386-283-8316
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICK MEYER
Credential	:	COTA
Telephone Number	:	386-283-8316

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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Directions to “KID SPOT ” Practice Location

Language	Start Address	Practice Location

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