Provider Demographics
NPI:1225586324
Name:YAY OT 4 KIDS, LLC
Entity Type:Organization
Organization Name:YAY OT 4 KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:828-582-7109
Mailing Address - Street 1:305 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3813
Mailing Address - Country:US
Mailing Address - Phone:910-685-7007
Mailing Address - Fax:910-516-1666
Practice Address - Street 1:305 N 15TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3813
Practice Address - Country:US
Practice Address - Phone:910-685-7007
Practice Address - Fax:910-516-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC170090636Medicaid