Provider Demographics
NPI:1629199146
Name:KIDSPOT THERAPY, PLLC
Entity Type:Organization
Organization Name:KIDSPOT THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAXLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:352-351-8300
Mailing Address - Street 1:425 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0615
Mailing Address - Country:US
Mailing Address - Phone:352-351-8300
Mailing Address - Fax:352-351-8310
Practice Address - Street 1:425 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0615
Practice Address - Country:US
Practice Address - Phone:352-351-8300
Practice Address - Fax:352-351-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-8330225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888133200Medicaid