Provider Demographics
NPI:1457517450
Name:THE KIDS OT WORKSHOP, LLC
Entity Type:Organization
Organization Name:THE KIDS OT WORKSHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:631-751-2227
Mailing Address - Street 1:213 HALLOCK RD
Mailing Address - Street 2:SUITE 2 B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3000
Mailing Address - Country:US
Mailing Address - Phone:631-751-2227
Mailing Address - Fax:
Practice Address - Street 1:213 HALLOCK RD
Practice Address - Street 2:SUITE 2 B
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3000
Practice Address - Country:US
Practice Address - Phone:631-751-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66586225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty