Provider Demographics
NPI:1245605815
Name:KID ADVENTURES PEDIATRIC THERAPY PLLC
Entity Type:Organization
Organization Name:KID ADVENTURES PEDIATRIC THERAPY PLLC
Other - Org Name:KID ADVENTURES PEDIATRIC THERAPY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-SLP
Authorized Official - Phone:337-251-1826
Mailing Address - Street 1:3027 WESTWOOD MANOR LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4662
Mailing Address - Country:US
Mailing Address - Phone:337-251-1826
Mailing Address - Fax:
Practice Address - Street 1:3027 WESTWOOD MANOR LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4662
Practice Address - Country:US
Practice Address - Phone:337-251-1826
Practice Address - Fax:281-974-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health