Provider Demographics
NPI:1639316615
Name:SKILLS TO BE A KID, OT SERVICES, PLLC
Entity Type:Organization
Organization Name:SKILLS TO BE A KID, OT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:CONSUELO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:516-208-9922
Mailing Address - Street 1:1818 BUSHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2941
Mailing Address - Country:US
Mailing Address - Phone:516-208-9922
Mailing Address - Fax:516-208-9922
Practice Address - Street 1:384 E 149TH ST
Practice Address - Street 2:SUITE 614
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3908
Practice Address - Country:US
Practice Address - Phone:718-585-0614
Practice Address - Fax:718-993-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011108225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty