Provider Demographics
NPI:1639466519
Name:KIDZ THERAPY ZONE LLC
Entity Type:Organization
Organization Name:KIDZ THERAPY ZONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:214-924-9213
Mailing Address - Street 1:515 W MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8000
Mailing Address - Country:US
Mailing Address - Phone:214-509-6961
Mailing Address - Fax:
Practice Address - Street 1:515 W MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8000
Practice Address - Country:US
Practice Address - Phone:214-509-6961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108019225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty