Healthcare Provider Details

I. General information

NPI: 1679843148
Provider Name (Legal Business Name): JLM VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REMINGTON COVE
LITTLE ROCK AR
72204-8202
US

IV. Provider business mailing address

5 REMINGTON COVE
LITTLE ROCK AR
72204-8202
US

V. Phone/Fax

Practice location:
  • Phone: 501-850-8788
  • Fax: 501-850-8788
Mailing address:
  • Phone: 501-850-8788
  • Fax: 501-850-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT743
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1275
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1484
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1096
License Number StateAR

VIII. Authorized Official

Name: MS. MELISSA W THOMAS
Title or Position: VP OF CLINIC OPERATIONS/SLP
Credential: M.S., CCC/SLP
Phone: 501-850-8788