NPIMap

Organization Active NPI

Kid Spirit, Inc.

  • Multi-Specialty Clinic/Center
  • Fort Myers, FL
National Provider Identifier
1275711889
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
OT10199 Issued in FL
Legal business name
KID SPIRIT, INC.
Practice address
9350 Camelot Dr
Fort Myers, FL 33919-7980
Phone
(239) 344-7217
NPI assigned
Feb 6, 2008
Last updated
Feb 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jaesen Petretta, OTR/LNPI 1073664173
Title
Owner/Partner
Phone
(239) 839-3408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X OT10199 FL Primary

Addresses

Primary practice location

9350 Camelot Dr
Fort Myers, FL 33919-7980

Mailing address

9350 Camelot Dr
Fort Myers, FL 33919-7980
Phone (239) 344-7217

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1275711889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9350 CAMELOT DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339197980",
            "telephone_number": "239-344-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9350 CAMELOT DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339197980",
            "telephone_number": "239-344-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KID SPIRIT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "PETRETTA",
        "authorized_official_first_name": "JAESEN",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "239-839-3408",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "FL",
            "license": "OT10199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.