Organization
AMAZING KIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA MICHELLE HERTEL OTR (OWNER)
(814) 715-5738
Entity
Organization
Contact information
Practice address
54 MARLIN ST, BROOKVILLE, PA 15825-1016
(814) 715-5738
Mailing address
54 MARLIN ST, BROOKVILLE, PA 15825-1016
(814) 715-5738
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC006656L
PA
225X00000X
Occupational Therapist
OC006801L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1014774800001
MEDICAL ASSISTANCE
PA
Enumeration date
03/27/2007
Last updated
09/18/2015
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