# KID SPIRIT, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275711889
- **Authorized official:** JAESEN PETRETTA OTR/L (OWNER/PARTNER)
- **Authorized official phone:** (239) 839-3408

## Contact information

- **Practice address:** 9350 CAMELOT DR, FORT MYERS, FL 33919-7980
- **Practice address phone:** (239) 344-7217
- **Mailing address:** 9350 CAMELOT DR, FORT MYERS, FL 33919-7980
- **Mailing address phone:** (239) 344-7217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | OT10199 | FL | Yes |

## Other

- **Enumeration date:** 02/06/2008
- **Last updated:** 02/06/2008