Organization
KIDABLE THERAPY
Active
Other names
Kidable
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAUREN VISTARAKULA OTD, OTR/L (OWNER)
(540) 315-3210
Entity
Organization
Contact information
Practice address
4335 BRAMBLETON AVE, ROANOKE, VA 24018-3404
(540) 315-3266
Mailing address
4335 BRAMBLETON AVE, ROANOKE, VA 24018-3404
(540) 315-3266
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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