Provider Demographics
NPI:1679802979
Name:KIDVENTURES OCCUPATIONAL THERAPY, PC
Entity Type:Organization
Organization Name:KIDVENTURES OCCUPATIONAL THERAPY, PC
Other - Org Name:KIDVENTURES THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALMER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:512-327-4499
Mailing Address - Street 1:5524 BEE CAVE RD
Mailing Address - Street 2:BLDG. L
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5245
Mailing Address - Country:US
Mailing Address - Phone:512-327-4499
Mailing Address - Fax:512-327-4495
Practice Address - Street 1:5524 BEE CAVE RD
Practice Address - Street 2:BLDG. L
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5245
Practice Address - Country:US
Practice Address - Phone:512-327-4499
Practice Address - Fax:512-327-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty