Organization
KIDD'S CONNECT OT, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE MIZE KIDD OT/L (OCCUPATIONAL THERAPIST/LICENSED)
(336) 870-7860
Entity
Organization
Contact information
Practice address
2457 FAIRVIEW FARM RD, ASHEBORO, NC 27205-8633
(336) 870-7860
(336) 458-9460
Mailing address
2457 FAIRVIEW FARM RD, ASHEBORO, NC 27205-8633
(336) 870-7860
(336) 458-9460
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00190815
—
NC
Enumeration date
05/03/2021
Last updated
05/03/2021
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