Healthcare Provider Details

I. General information

NPI: 1093447179
Provider Name (Legal Business Name): MEETING MILESTONES CHILDREN'S THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 PHILLIPS DR
PARAGOULD AR
72450-2656
US

IV. Provider business mailing address

4307 PHILLIPS DR
PARAGOULD AR
72450-2656
US

V. Phone/Fax

Practice location:
  • Phone: 870-919-8739
  • Fax:
Mailing address:
  • Phone: 870-919-8739
  • Fax:

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 TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRENT RAY
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential:
Phone: 870-919-8739