Provider Demographics
NPI:1861425126
Name:O. T. 4 KIDS, INC
Entity type:Organization
Organization Name:O. T. 4 KIDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANQUELEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-795-5552
Mailing Address - Street 1:335 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4456
Mailing Address - Country:US
Mailing Address - Phone:352-795-5552
Mailing Address - Fax:352-795-7751
Practice Address - Street 1:335 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4456
Practice Address - Country:US
Practice Address - Phone:352-795-5552
Practice Address - Fax:352-795-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830037201Medicaid
FL120773301Medicaid
FL120773300Medicaid
FL830037200Medicaid