Provider Demographics
NPI:1063802114
Name:KIDS IN MOTION
Entity type:Organization
Organization Name:KIDS IN MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-684-9610
Mailing Address - Street 1:6281 MIDDLE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-202-7510
Mailing Address - Fax:
Practice Address - Street 1:2636 S. MILFORD ROAD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357
Practice Address - Country:US
Practice Address - Phone:248-684-9610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004079385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22OtherTAXONOMY