Provider Demographics
NPI:1760579015
Name:INNOVATIVE THERAPY 4 KIDS INC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY 4 KIDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MOTOR SPECIALIST DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCCSLP
Authorized Official - Phone:760-434-3912
Mailing Address - Street 1:2333 STATE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1691
Mailing Address - Country:US
Mailing Address - Phone:760-434-3912
Mailing Address - Fax:760-434-3871
Practice Address - Street 1:2333 STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1691
Practice Address - Country:US
Practice Address - Phone:760-434-3912
Practice Address - Fax:760-434-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9589103T00000X, 103TC0700X, 2251P0200X, 225XN1300X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty