Basic Information
| Provider Information | |||||||||
| NPI: | 1780014480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDSTLC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 S ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133243636 | ||||||||
| FaxNumber: | 9137803387 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 S ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133243823 | ||||||||
| FaxNumber: | 9137803387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2013 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9133243681 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225XM0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | 235Z00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.