Provider Demographics
NPI:1407259393
Name:NORTHSHORE KIDS THERAPY
Entity Type:Organization
Organization Name:NORTHSHORE KIDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:210-725-6438
Mailing Address - Street 1:1524 DARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6041
Mailing Address - Country:US
Mailing Address - Phone:210-725-6438
Mailing Address - Fax:
Practice Address - Street 1:1524 DARLINGTON ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6041
Practice Address - Country:US
Practice Address - Phone:210-725-6438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200774225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty