Provider Demographics
NPI:1821255522
Name:KIDZ THERAPIES OF STATESBORO
Entity Type:Organization
Organization Name:KIDZ THERAPIES OF STATESBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:912-232-9700
Mailing Address - Street 1:PO BOX 1605
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1605
Mailing Address - Country:US
Mailing Address - Phone:912-489-1258
Mailing Address - Fax:912-764-7006
Practice Address - Street 1:109 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4898
Practice Address - Country:US
Practice Address - Phone:912-489-1258
Practice Address - Fax:912-764-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty