Provider Demographics
NPI:1518529635
Name:KID FUNDAMENTALS THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:KID FUNDAMENTALS THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L
Authorized Official - Phone:714-750-9700
Mailing Address - Street 1:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92684-1726
Mailing Address - Country:US
Mailing Address - Phone:714-750-9700
Mailing Address - Fax:
Practice Address - Street 1:12900B GARDEN GROVE BLVD STE 235
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2027
Practice Address - Country:US
Practice Address - Phone:714-750-9700
Practice Address - Fax:714-750-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770874299OtherNPI TYPE 1