Provider Demographics
NPI:1811225634
Name:KIDIATRIX THERAPY, INC.
Entity Type:Organization
Organization Name:KIDIATRIX THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KELBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-491-3960
Mailing Address - Street 1:6614 SW 114TH PL
Mailing Address - Street 2:UNIT B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1781
Mailing Address - Country:US
Mailing Address - Phone:305-491-3960
Mailing Address - Fax:305-596-4676
Practice Address - Street 1:6614 SW 114TH PL
Practice Address - Street 2:UNIT B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1781
Practice Address - Country:US
Practice Address - Phone:305-491-3960
Practice Address - Fax:305-596-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty