Provider Demographics
NPI:1710561667
Name:WONDERKIDS OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:WONDERKIDS OCCUPATIONAL THERAPY, LLC
Other - Org Name:WONDERKIDS THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L; NTMTC
Authorized Official - Phone:915-253-1691
Mailing Address - Street 1:12601 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5009
Mailing Address - Country:US
Mailing Address - Phone:352-559-9500
Mailing Address - Fax:352-559-0585
Practice Address - Street 1:12601 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5009
Practice Address - Country:US
Practice Address - Phone:352-559-9500
Practice Address - Fax:352-559-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty