Provider Demographics
NPI:1902252059
Name:KINETIC KIDS, INC.
Entity Type:Organization
Organization Name:KINETIC KIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/ PRES.
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-219-1908
Mailing Address - Street 1:421 WOODS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-5604
Mailing Address - Country:US
Mailing Address - Phone:606-219-1908
Mailing Address - Fax:606-678-0874
Practice Address - Street 1:421 WOODS EDGE DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-5604
Practice Address - Country:US
Practice Address - Phone:606-219-1908
Practice Address - Fax:606-678-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001530252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency