Healthcare Provider Details

I. General information

NPI: 1467536466
Provider Name (Legal Business Name): CHILDREN'S THERAPY TEAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 E JOYCE BLVD SUITE 2
FAYETTEVILLE AR
72703-4519
US

IV. Provider business mailing address

2474 E JOYCE BLVD SUITE 2
FAYETTEVILLE AR
72703-4519
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8326
  • Fax: 479-521-5439
Mailing address:
  • Phone: 479-521-8326
  • Fax: 479-521-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR2064
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2309
License Number StateAR

VIII. Authorized Official

Name: KYMBRLY HANNAH
Title or Position: PRESIDENT
Credential: PT
Phone: 479-521-8326