Provider Demographics
NPI:1093930687
Name:DYNAMIC PEDIATRICS
Entity Type:Organization
Organization Name:DYNAMIC PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:CAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:254-466-0740
Mailing Address - Street 1:2501 S W S YOUNG DR STE 413
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2006
Mailing Address - Country:US
Mailing Address - Phone:245-616-1676
Mailing Address - Fax:254-616-1677
Practice Address - Street 1:2501 S W S YOUNG DR STE 413
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2006
Practice Address - Country:US
Practice Address - Phone:254-616-1676
Practice Address - Fax:254-616-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108369225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty