Provider Demographics
NPI:1043918378
Name:CONNECTED KIDS PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:CONNECTED KIDS PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTENA
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:023-413-7706
Mailing Address - Street 1:20588 S ELLSWORTH LOOP RD APT 3125
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-0146
Mailing Address - Country:US
Mailing Address - Phone:602-341-3770
Mailing Address - Fax:602-560-0504
Practice Address - Street 1:20588 S ELLSWORTH LOOP RD APT 3125
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-0146
Practice Address - Country:US
Practice Address - Phone:602-341-3770
Practice Address - Fax:602-560-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty