Provider Demographics
NPI:1285465898
Name:DINOMITE KIDS PEDIATRIC THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:DINOMITE KIDS PEDIATRIC THERAPY SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO; SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:SAREM
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:210-982-2802
Mailing Address - Street 1:332 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERTRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78605-4414
Mailing Address - Country:US
Mailing Address - Phone:210-982-2802
Mailing Address - Fax:
Practice Address - Street 1:1800 MORMON MILL RD STE A2
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4176
Practice Address - Country:US
Practice Address - Phone:210-982-2802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty