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Kidspace Therapy, Llc
Developmental Disabilities Clinic/Center in Longview, Washington
NPI 1184019184

Kidspace Therapy, Llc is a Developmental Disabilities Clinic/Center based in Longview, WA and is specialized in Developmental Disabilities. Kidspace Therapy, Llc practices in Longview, WA. The NPI Number for Kidspace Therapy, Llc is 1184019184 and holds a License No. OT00001294 (Washington).

The current practice location address for Kidspace Therapy, Llc is 2145 Tibbetts Dr Ste A, Longview, WA and can be reached out via phone at 360-560-1972 and via fax at 360-703-3452. You can also correspond with Kidspace Therapy, Llc through the mailing address at 2145 TIBBETTS DR STE A, LONGVIEW, WA - 98632-4211 (mailing address contact number: 360-560-1972).

Location: 2145 Tibbetts Dr Ste A, Longview, WA, 98632-4211
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1184019184
Provider Name
Kidspace Therapy, Llc
Credential
Provider Entity Type
Organization
Address
2145 Tibbetts Dr Ste A, Longview, WA, 98632-4211
Phone Number
360-560-1972
Fax Number
360-703-3452
Provider Enumeration Date
04/06/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1801921531 01 WA INDIVIDUAL NPI
2043730 05 WA
603464065 01 WA UBI
institution
Provider Business Practice Location Address Details
Address
2145 Tibbetts Dr Ste A
City
Longview
State
Washington
Zip
98632-4211
Phone Number
360-560-1972
Fax Number
360-703-3452
person
Provider Business Mailing Address Details
Address
2145 Tibbetts Dr Ste A
City
Longview
State
Washington
Zip
98632-4211
Phone Number
360-560-1972
Fax Number
360-703-3452
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
603464065 (Washington)
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Developmental Disabilities
Taxonomy
261QD1600X
License No.
OT00001294 (Washington)
Definition
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
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