Provider Demographics
NPI:1285884163
Name:JUST FOR KIDS
Entity type:Organization
Organization Name:JUST FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MSR, OTR/L
Authorized Official - Phone:864-962-6832
Mailing Address - Street 1:11 MARTELE CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7615
Mailing Address - Country:US
Mailing Address - Phone:864-962-6832
Mailing Address - Fax:
Practice Address - Street 1:11 MARTELE CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7615
Practice Address - Country:US
Practice Address - Phone:864-962-6832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1487735700OtherNPI
FL889545700Medicaid
SCTH1231Medicaid
SC1053578724OtherNPI