MEDICARE: OT KIDZ STYLE, 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	OT001615	GA

General Provider Information

NPI Number	:	1649378951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OT KIDZ STYLE, INC.

Provider Business Mailing Address
First Line	:	2131 MCDOWELL ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4490
Country	:	US
Telephone Number	:	706-339-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 MCDOWELL ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4490
Country	:	US
Telephone Number	:	706-339-4026
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	REGINA RAY
Credential	:
Telephone Number	:	706-339-4026

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “OT KIDZ STYLE, INC. ” Practice Location

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