MEDICARE: KIDS UNLIMITED OF WASHINGTON COUTNY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871932319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS UNLIMITED OF WASHINGTON COUTNY, INC.

Provider Business Mailing Address
First Line	:	120 SOUTHWINDS RD STE 2
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8652
Country	:	US
Telephone Number	:	479-300-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 SOUTHWINDS RD STE 2
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8652
Country	:	US
Telephone Number	:	479-300-6400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHELLY DECKER
Credential	:	MCD, CCC-SLP
Telephone Number	:	870-761-6680

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	12/29/2014

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