Provider Demographics
NPI:1790237758
Name:KIDZONE THERAPY PLLC
Entity Type:Organization
Organization Name:KIDZONE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERTHERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:903-744-4421
Mailing Address - Street 1:504 E YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-4518
Mailing Address - Country:US
Mailing Address - Phone:903-744-4421
Mailing Address - Fax:
Practice Address - Street 1:504 E YOUNG ST
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:TX
Practice Address - Zip Code:75459-4518
Practice Address - Country:US
Practice Address - Phone:903-744-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212012224Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty