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Organization

COUNTRY KIDS INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LISA KAFKA OTR (EXECUTIVE DIRECTOR)
(920) 339-0700
Entity
Organization

Contact information

Practice address
1142 ORLANDO DR, DE PERE, WI 54115-9484
(920) 339-0700
(920) 330-0278
Mailing address
1142 ORLANDO DR, DE PERE, WI 54115-9484
(920) 339-0700
(920) 330-0278

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
225100000X
Physical Therapist
2251P0200X
Pediatric Physical Therapist
225200000X
Physical Therapy Assistant
225X00000X
Occupational Therapist
225XP0200X
Pediatric Occupational Therapist
235Z00000X
Speech-Language Pathologist
261QD1600X
Developmental Disabilities Clinic/Center
Primary
261QH0700X
Hearing and Speech Clinic/Center
261QP2000X
Physical Therapy Clinic/Center
261QX0100X
Occupational Medicine Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
41217200
WI
Enumeration date
09/16/2006
Last updated
08/28/2008
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