Provider Demographics
NPI:1023739786
Name:CONFIDENT KIND INCLUSIVE DEVELOPMENT ZONE PT AND OT PLLC
Entity type:Organization
Organization Name:CONFIDENT KIND INCLUSIVE DEVELOPMENT ZONE PT AND OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:HURLEY-
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-848-0875
Mailing Address - Street 1:15801 CROSSBAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3140
Mailing Address - Country:US
Mailing Address - Phone:718-848-0875
Mailing Address - Fax:
Practice Address - Street 1:15801 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3140
Practice Address - Country:US
Practice Address - Phone:718-848-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty