Healthcare Provider Details

I. General information

NPI: 1346979663
Provider Name (Legal Business Name): FIRST STEP ARKANSAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S DIVISION ST
BLYTHEVILLE AR
72315-5445
US

IV. Provider business mailing address

2911 LONGVIEW DR
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-763-2390
  • Fax:
Mailing address:
  • Phone: 870-336-0238
  • Fax: 870-336-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMILY ASTON
Title or Position: CFO
Credential:
Phone: 870-336-0238