Provider Demographics
NPI:1487307906
Name:THE KID SPOT FOR SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPY, PLLC
Entity type:Organization
Organization Name:THE KID SPOT FOR SPEECH, PHYSICAL, AND OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KITSOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-491-2655
Mailing Address - Street 1:77 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1726
Mailing Address - Country:US
Mailing Address - Phone:516-495-4898
Mailing Address - Fax:
Practice Address - Street 1:77 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1726
Practice Address - Country:US
Practice Address - Phone:516-495-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty