Provider Demographics
NPI:1992183347
Name:KIDS THERAPY CONNECTION, LLC
Entity Type:Organization
Organization Name:KIDS THERAPY CONNECTION, LLC
Other - Org Name:MY KIDS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:410-451-5700
Mailing Address - Street 1:1166 MARYLAND ROUTE 3 S STE 109
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1773
Mailing Address - Country:US
Mailing Address - Phone:410-451-5700
Mailing Address - Fax:410-451-5703
Practice Address - Street 1:8717 GREENBELT RD STE 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2480
Practice Address - Country:US
Practice Address - Phone:301-553-2370
Practice Address - Fax:410-451-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty