Provider Demographics
NPI:1700834181
Name:CAPABLE KIDS HOME THERAPY CO.
Entity Type:Organization
Organization Name:CAPABLE KIDS HOME THERAPY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:704-965-0783
Mailing Address - Street 1:7427 MATTHEWS-MINT HILL RD.
Mailing Address - Street 2:SUITE 105 PMB 168
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227
Mailing Address - Country:US
Mailing Address - Phone:704-965-0783
Mailing Address - Fax:704-545-8021
Practice Address - Street 1:5717 WHITEHAWK HILL RD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-965-0783
Practice Address - Fax:704-545-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211782Medicaid