MEDICARE: KIDS THERAPY AT HOME 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1639425226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS THERAPY AT HOME LLC

Provider Business Mailing Address
First Line	:	203 COBBLESTONE LN
Second Line	:
City	:	CRAWFORD
State	:	TX
Zip	:	76638-2732
Country	:	US
Telephone Number	:	855-335-5437
Fax Number	:	254-235-3408

Provider Business Practice Location Address
First Line	:	6701 SANGER AVE
Second Line	:	STE. 104
City	:	WACO
State	:	TX
Zip	:	76710-7737
Country	:	US
Telephone Number	:	855-335-5437
Fax Number	:	254-235-3408

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. JULIET R. MELTON
Credential	:	PT
Telephone Number	:	855-335-5437

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	10/02/2014

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