Healthcare Provider Details

I. General information

NPI: 1164726584
Provider Name (Legal Business Name): KIDSPIRATION OUTPATIENT THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 BRADLEY DR
MOUNTAIN HOME AR
72653-2730
US

IV. Provider business mailing address

1310 BRADLEY DRIVE
MTN HOME AR
72654
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-4021
  • Fax: 870-424-4112
Mailing address:
  • Phone: 870-424-4021
  • Fax: 870-424-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE COLEMAN
Title or Position: OWNER
Credential:
Phone: 870-424-4021