Provider Demographics
NPI:1508183443
Name:KIDS IN BALANCE
Entity Type:Organization
Organization Name:KIDS IN BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:D'AMICO SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MOT,OTR/L
Authorized Official - Phone:414-378-5303
Mailing Address - Street 1:2555 N GORDON PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3018
Mailing Address - Country:US
Mailing Address - Phone:414-378-5303
Mailing Address - Fax:414-376-5552
Practice Address - Street 1:2555 N GORDON PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3018
Practice Address - Country:US
Practice Address - Phone:414-378-5303
Practice Address - Fax:414-376-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006553252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency