Provider Demographics
NPI:1083005037
Name:THE KID SPOT
Entity Type:Organization
Organization Name:THE KID SPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AND OT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:270-465-7768
Mailing Address - Street 1:121 CASEY ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-6858
Mailing Address - Country:US
Mailing Address - Phone:270-465-7768
Mailing Address - Fax:
Practice Address - Street 1:121 CASEY ST STE A
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-6858
Practice Address - Country:US
Practice Address - Phone:270-465-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty