Provider Demographics
NPI:1598055204
Name:EXCEPTIONAL KIDZ REHAB ACADEMY
Entity Type:Organization
Organization Name:EXCEPTIONAL KIDZ REHAB ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:305-310-3267
Mailing Address - Street 1:1414 NW 107TH AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1414 NW 107TH AVE
Practice Address - Street 2:STE 204
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:305-310-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3208225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty