Organization
SUPERKIDZ PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM CALDWELL (COTA)
(803) 509-3495
Entity
Organization
Contact information
Practice address
1700 QUAIL LAKE DR, WEST COLUMBIA, SC 29169-3746
(803) 509-3459
Mailing address
1700 QUAIL LAKE DR, WEST COLUMBIA, SC 29169-3746
(803) 509-3459
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT4566
SC
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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