Provider Demographics
NPI:1790674646
Name:DRAGONFLY KIDS THERAPY, LLC
Entity type:Organization
Organization Name:DRAGONFLY KIDS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA PENA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:830-203-0904
Mailing Address - Street 1:7631 PONDEROSA PNE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5141
Mailing Address - Country:US
Mailing Address - Phone:830-203-0904
Mailing Address - Fax:
Practice Address - Street 1:7631 PONDEROSA PNE
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-5141
Practice Address - Country:US
Practice Address - Phone:830-203-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty