Provider Demographics
NPI:1346561248
Name:KID POWER, INC
Entity Type:Organization
Organization Name:KID POWER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:502-338-9216
Mailing Address - Street 1:17000 HIGHWAY 148
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023
Mailing Address - Country:US
Mailing Address - Phone:502-338-0216
Mailing Address - Fax:
Practice Address - Street 1:17700 HIGHWAY 148
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-9731
Practice Address - Country:US
Practice Address - Phone:502-338-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1713251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health