Healthcare Provider Details

I. General information

NPI: 1053062737
Provider Name (Legal Business Name): SOAR DEVELOPMENTAL AND BEHAVIORAL THERAPIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 FINANCIAL CENTRE PKWY
LITTLE ROCK AR
72211-3715
US

IV. Provider business mailing address

PO BOX 26347
LITTLE ROCK AR
72221-6347
US

V. Phone/Fax

Practice location:
  • Phone: 501-215-1654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. HAYDEN CHENAULT
Title or Position: OWNER
Credential: OTD, OTR/L
Phone: 501-215-1654