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Organization
KIDTALK, P.A.
Active
Organization
KIDTALK, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AIMEE JENNINGS (PRESIDENT)
(904) 964-4464
Entity
Organization
Contact information
Practice address
417 W CALL ST, STARKE, FL 32091-3115
(904) 964-4464
Mailing address
2162 NE 154TH ST, STARKE, FL 32091-6418
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
OT 8454
FL
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SA5788
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
811712800
—
FL
05
—
889841300
—
FL
01
—
T0929
BLUE CROSS
FL
01
—
Y928V
BLUE CROSS
FL
Enumeration date
06/04/2006
Last updated
02/05/2009
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