Provider Demographics
NPI:1316658065
Name:KIDS IN MOTION MOBILE PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:KIDS IN MOTION MOBILE PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCLEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:405-627-3159
Mailing Address - Street 1:10613 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6003
Mailing Address - Country:US
Mailing Address - Phone:405-627-3159
Mailing Address - Fax:
Practice Address - Street 1:10613 NW 38TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6003
Practice Address - Country:US
Practice Address - Phone:405-627-3159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty