Healthcare Provider Details

I. General information

NPI: 1730527391
Provider Name (Legal Business Name): KIDS BEING KIDS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HOLLY BROOK CV
MAUMELLE AR
72113-6881
US

IV. Provider business mailing address

PO BOX 13932
MAUMELLE AR
72113-0932
US

V. Phone/Fax

Practice location:
  • Phone: 501-951-0655
  • Fax:
Mailing address:
  • Phone: 501-951-0655
  • 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 Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MIGUET
Title or Position: VP/OWNER
Credential:
Phone: 501-951-0655