Healthcare Provider Details

I. General information

NPI: 1851016547
Provider Name (Legal Business Name): MOTOR MOUTH PEDIATRIC THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/08/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 PENNINGTON DR STE A
PARIS AR
72855-3747
US

IV. Provider business mailing address

9401 N STATE HIGHWAY 23
MAGAZINE AR
72943-8443
US

V. Phone/Fax

Practice location:
  • Phone: 479-675-6224
  • Fax:
Mailing address:
  • Phone: 479-675-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAMON BEAUCHAMP
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 479-675-6224