| NPI | 1790747962 |
|---|---|
| Doing Business As | KIDDOS' CLUBHOUSE |
| Entity Type | Organization |
| Authorized Contact | BRETT RUSSELL DEVORE Owner 678-527-3224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: GA OT002774) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-08-22 |