Provider Demographics
NPI:1982909560
Name:THE KIOKO CENTER LLC
Entity Type:Organization
Organization Name:THE KIOKO CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/LEADING OT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:OTD OTR/L
Authorized Official - Phone:978-681-6605
Mailing Address - Street 1:820 TURNPIKE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 TURNPIKE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6125
Practice Address - Country:US
Practice Address - Phone:978-681-6605
Practice Address - Fax:978-681-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA727452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790089399OtherBLUE CROSS BLUE SHIELD & HARVARD PILGRIM