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Organization

KIDS LEAD, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVIS CARMACK MS, OTD, OTR/L (CHIEF EXECUTIVE OFFICER)
(630) 800-6083
Entity
Organization

Contact information

Practice address
5619 NW 86TH ST, JOHNSTON, IA 50131-1819
(515) 218-9160
Mailing address
624 37TH ST, DES MOINES, IA 50312-3306
(630) 800-6083

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary

Other

Enumeration date
12/11/2023
Last updated
12/11/2023
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