Organization
KIDMOTION: BRENDA CHILSTROM, PEDIATRIC OCCUPATIONAL THERAPY, LLC
Active
Organization
KIDMOTION: BRENDA CHILSTROM, PEDIATRIC OCCUPATIONAL THERAPY, LLC
Active
Other names
KidMotion
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA CHILSTROM OTR/L (OWNER)
(239) 595-7018
Entity
Organization
Contact information
Practice address
15541 MARCELLO CIR, NAPLES, FL 34110-2836
(239) 595-7018
(239) 495-1792
Mailing address
15541 MARCELLO CIR, NAPLES, FL 34110-2836
(239) 595-7018
(239) 495-1792
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
9691
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
886061100
—
FL
01
—
Z9456
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
FL
Enumeration date
12/11/2014
Last updated
12/11/2014
Update your record
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