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Organization

KIDSPROUT THERAPY

Active
Other names
KidSprout Therapy
Organization subpart
No

Provider details

NPI number
Authorized official
SAJINA COOPER (ADMINISTRATIVE DIRECTOR)
(919) 641-1803
Entity
Organization

Contact information

Practice address
10405 STALLION WAY, BAHAMA, NC 27503-9631
(919) 641-1803
(919) 287-2869
Mailing address
10405 STALLION WAY, BAHAMA, NC 27503-9631
(919) 641-1803
(919) 287-2869

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
225X00000X
Occupational Therapist
235Z00000X
Speech-Language Pathologist
Primary
251S00000X
Community/Behavioral Health Agency

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7200576
NC
Enumeration date
01/16/2013
Last updated
04/18/2022
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