Provider Demographics
NPI:1124674205
Name:CHILDRENS OCCUPATIONAL THERAPY, INC
Entity type:Organization
Organization Name:CHILDRENS OCCUPATIONAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KITAINIK
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:702-271-0661
Mailing Address - Street 1:9508 MOUNTAINAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6219
Mailing Address - Country:US
Mailing Address - Phone:702-271-0661
Mailing Address - Fax:
Practice Address - Street 1:9508 MOUNTAINAIR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6219
Practice Address - Country:US
Practice Address - Phone:702-271-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1811140023Medicaid