MEDICARE: DRAGONFLY KIDS THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	2251P0200X	Pediatric Physical Therapist
3	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1790674646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGONFLY KIDS THERAPY

Provider Business Mailing Address
First Line	:	24123 BOERNE STAGE RD STE 210
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-9406
Country	:	US
Telephone Number	:	830-203-0904
Fax Number	:	830-272-5807

Provider Business Practice Location Address
First Line	:	24123 BOERNE STAGE RD STE 210
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-9406
Country	:	US
Telephone Number	:	830-203-0904
Fax Number	:	830-272-5807

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	AVERY DE LA PENA
Credential	:	OTR
Telephone Number	:	830-203-0904

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	04/13/2026

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Directions to “DRAGONFLY KIDS THERAPY ” Practice Location

Language	Start Address	Practice Location

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