Healthcare Provider Details

I. General information

NPI: 1801352554
Provider Name (Legal Business Name): KIDSPIRATION TOO PEDIATRIC THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 MAIN ST
MELBOURNE AR
72556-8205
US

IV. Provider business mailing address

PO BOX 967
MELBOURNE AR
72556-0967
US

V. Phone/Fax

Practice location:
  • Phone: 870-368-4586
  • Fax: 870-368-4587
Mailing address:
  • Phone: 870-368-4586
  • Fax: 870-368-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLOTTE CLAXTON
Title or Position: BILLING MGR
Credential:
Phone: 870-847-4447