Organization
KIDSPACE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE KAY WOLFF OTR/L (OWNER)
(360) 560-1972
Entity
Organization
Contact information
Practice address
2145 TIBBETTS DR STE A, LONGVIEW, WA 98632-4211
(360) 560-1972
(360) 703-3452
Mailing address
2145 TIBBETTS DR STE A, LONGVIEW, WA 98632-4211
(360) 560-1972
(360) 703-3452
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
OT00001294
WA
261QD1600X
Developmental Disabilities Clinic/Center
Primary
603464065
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801921531
INDIVIDUAL NPI
WA
05
—
2043730
—
WA
01
—
603464065
UBI
WA
Enumeration date
04/06/2015
Last updated
07/15/2020
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