Healthcare Provider Details

I. General information

NPI: 1285983148
Provider Name (Legal Business Name): SPEER PEDIATRIC THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 EAST NETTLETON SUITE D
JONESBORO AR
72401
US

IV. Provider business mailing address

2729 E NETTLETON AVE STE B
JONESBORO AR
72401-4545
US

V. Phone/Fax

Practice location:
  • Phone: 870-275-6438
  • Fax: 870-275-6439
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT3045
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1928
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#2878
License Number StateAR

VIII. Authorized Official

Name: MRS. WENDI SPEER
Title or Position: OWNER
Credential: MPT
Phone: 870-275-6438