Kidpro Therapies, Inc

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

KIDPRO THERAPIES, INC

Practice address

10702 SW Elsinore Dr
Port Saint Lucie, FL 34987-2149

Phone

(772) 260-9499

NPI assigned

Apr 5, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Jennifer L Wild, OTRNPI 1396867750

Title

President

Phone

(772) 260-9499

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer L Wild, OTR

  • Occupational Therapist
  • Port Saint Lucie, FL
  • NPI 1396867750
  NPD Authorized official

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1467574723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8651 SW CRUDEN BAY CT",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349974206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10702 SW ELSINORE DR",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872149",
            "telephone_number": "772-260-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDPRO THERAPIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-05",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "WILD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-260-9499",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "830086100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Matthew Key, D.C.
• Mona Khalil, AP
• Shyamazan Khan
• Maged A Khodeir, RPH
• Deborah Ann Kicliter-Kelley, ARNP
• Kind Hands Behavioral Services LLC
• Kinect Therapy Services
• Matthew Benjamin King, RN
• Matthew Kingrey, LCSW
• Jennifer Kinkade, OTRL

• Occupational Therapist in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.