MEDICARE: SMART KIDS 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1790349694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART KIDS THERAPY INC

Provider Business Mailing Address
First Line	:	2469 W 2ND ST FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5919
Country	:	US
Telephone Number	:	718-787-7081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2469 W 2ND ST FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5919
Country	:	US
Telephone Number	:	718-787-7081
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. VICTORIA BAKLEY
Credential	:	M.S. ED
Telephone Number	:	718-787-7081

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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