Healthcare Provider Details

I. General information

NPI: 1083852479
Provider Name (Legal Business Name): THERA-PLAY PEDIATRIC THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 FOX RD SUITE A
JONESBORO AR
72404-9322
US

IV. Provider business mailing address

3114 FOX RD SUITE A
JONESBORO AR
72404-9322
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9294
  • Fax: 870-933-9293
Mailing address:
  • Phone: 870-933-9294
  • Fax: 870-933-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDI STEELE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 870-926-7725