Organization
KID SPIRIT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAESEN PETRETTA OTR/L (OWNER/PARTNER)
(239) 839-3408
Entity
Organization
Contact information
Practice address
9350 CAMELOT DR, FORT MYERS, FL 33919-7980
(239) 344-7217
Mailing address
9350 CAMELOT DR, FORT MYERS, FL 33919-7980
(239) 344-7217
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
OT10199
FL
Other
Enumeration date
02/06/2008
Last updated
02/06/2008
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