Organization
KIDSPROUT THERAPY
Active
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
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/09/2014
Last updated
04/18/2022
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