Healthcare Provider Details

I. General information

NPI: 1568959179
Provider Name (Legal Business Name): KIDDOS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 ELLIS ST STE 200
FORT SMITH AR
72916-6106
US

IV. Provider business mailing address

7411 ELLIS ST STE 200
FORT SMITH AR
72916-6106
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-3414
  • Fax: 479-242-3415
Mailing address:
  • Phone: 479-242-3414
  • Fax: 479-242-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JODI CABANESS
Title or Position: OWNER/DIRECTOR
Credential: PT
Phone: 479-970-8351