Provider Demographics
NPI:1164824348
Name:KIDS THERAPY OTR INC
Entity Type:Organization
Organization Name:KIDS THERAPY OTR INC
Other - Org Name:KIDS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARIABEK-POURA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:818-471-3344
Mailing Address - Street 1:20812 VENTURA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2342
Mailing Address - Country:US
Mailing Address - Phone:818-471-3344
Mailing Address - Fax:818-884-5369
Practice Address - Street 1:20812 VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2342
Practice Address - Country:US
Practice Address - Phone:818-471-3344
Practice Address - Fax:818-884-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5767252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency