Healthcare Provider Details

I. General information

NPI: 1013008838
Provider Name (Legal Business Name): ALL GOD'S CHILDREN THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST STE 4
JACKSONVILLE AR
72076-4139
US

IV. Provider business mailing address

601 N 1ST ST STE 4
JACKSONVILLE AR
72076-4139
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax: 501-241-0125
Mailing address:
  • Phone: 501-241-0410
  • Fax: 501-241-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1657
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#2013
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 2238
License Number StateAR

VIII. Authorized Official

Name: MRS. MARCIA JANE SHEPHERD
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 501-241-0410