Provider Demographics
NPI:1417054180
Name:KELLIE'S KIDZ, LLC
Entity Type:Organization
Organization Name:KELLIE'S KIDZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:228-872-3042
Mailing Address - Street 1:1528 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-9543
Mailing Address - Country:US
Mailing Address - Phone:228-872-3042
Mailing Address - Fax:
Practice Address - Street 1:1528 S 11TH ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-9543
Practice Address - Country:US
Practice Address - Phone:228-872-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06733797Medicaid
MS00119909Medicaid