KID SPIRIT, INC.
NPI 1275711889
Clinic/Center - Multi-Specialty in Fort Myers, FL

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.

Active since February 06, 2008

9350 CAMELOT DR, FORT MYERS, FL 33919(239) 344-7217 Get Directions Write a Review

NPPES record last updated: February 6, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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NPI Profile Information
Primary Taxonomy
Authorized Official
Other Providers Same Location
Frequently Asked Questions

Organization
Clinic/Center
Multi-Specialty

About KID SPIRIT, INC.

This page provides the complete NPI Profile along with additional information for Kid Spirit, Inc., a provider established in Fort Myers, Florida operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1275711889 assigned on February 2008. The practitioner's primary taxonomy code is 261QM1300X with license number OT10199 (FL). The provider is registered as an organization and their NPI record was last updated 18 years ago. The authorized official of this NPI record is Jaesen Petretta Otr/l (Owner/partner)

NPI: 1275711889 Verify this NPI
Provider Name: KID SPIRIT, INC.
Entity Type: Organization
Location Address: 9350 CAMELOT DR FORT MYERS, FL 33919
Location Phone: (239) 344-7217
Mailing Address: 9350 CAMELOT DR FORT MYERS, FL 33919
Mailing Phone: (239) 344-7217
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 02-06-2008
Last Update Date: 02-06-2008
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Clinic/Center Multi-Specialty
Taxonomy Code: 261QM1300X
Type: Ambulatory Health Care Facilities
License No.: OT10199
License State: FL

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: JAESEN PETRETTA OTR/L
Authorized Official Title: OWNER/PARTNER
Authorized Official Phone: (239) 839-3408