KIDSPACE THERAPY, LLC (NPI# 1184019184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184019184 |
| Entity Type | Organization |
| Organization Name | KIDSPACE THERAPY, LLC |
| Practice Address |
2145 Tibbetts Dr Ste A Longview WA 98632-4211 |
| Practice Telephone | 3605601972 |
| Practice Fax Number | 3607033452 |
| Mailing Telephone | 3605601972 |
| Mailing Fax Number | 3607033452 |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2020-07-15 |
| Authorized Official Name | LESLIE KAY WOLFF (OWNER) |
| Authorized Official Telephone | 3605601972 |
| Authorized Official Credential | OTR/L |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | OT00001294 | WA | Ambulatory Health Care Facilities |
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
603464065 | WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | INDIVIDUAL NPI | 1801921531 | 01 |
| WA | 2043730 | 05 | |
| WA | UBI | 603464065 | 01 |
| Street Address |
2145 TIBBETTS DR STE A |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632-4211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346591153 | Karrie J Petersen | Speech-Language Pathologist | 2145 Tibbetts Dr Ste A, Longview, WA 98632 | 2012-09-20 |
| 1629569181 | Kelly Baierl | Speech-Language Pathologist | 2145 Tibbetts Dr Ste A, Longview, WA 98632-4211 | 2018-05-21 |
| 1861990533 | Mckinzi M Williams | Occupational Therapist | 2145 Tibbetts Dr Ste A, Longview, WA 98632-4211 | 2018-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417446535 | Responding To Autism Services Inc. | Clinic/Center | 4206 W 24th Ave Ste B101, Kennewick, WA 99338-2321 | 2018-05-03 |
| 1609228774 | Kidsmarts | Clinic/Center | 2518 E Calhoun St, Seattle, WA 98112-2616 | 2016-07-12 |
| 1942625611 | Kristen Williams | Clinic/Center | 5112 Nw Taylor Rd., Bremerton, WA 98312 | 2014-03-04 |
| 1114098274 | Early Choice Pediatric Therapy, Pllc | Clinic/Center | 106 E 15th St, Vancouver, WA 98663-3401 | 2006-11-12 |
| 1598716748 | Innovative Services Nw | Clinic/Center | 9414 Ne Fourth Plain Road, Vancouver, WA 98662 | 2006-05-12 |
| 1265776918 | Public Hospital Dist No 1 Skagit | Clinic/Center | 1415 E Kincaid St, Mount Vernon, WA 98274-4126 | 2012-11-19 |
| 1407113236 | Olympic Peninsula Autism Center | Clinic/Center | 3500 Nw Bucklin Hill Rd, Suite 101, Silverdale, WA 98383-8503 | 2012-04-18 |
| 1144377094 | Childrens Hospital | Clinic/Center | 1135 116th Ave Ne, Bellevue, WA 98004-4623 | 2007-01-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.