Healthcare Provider Details

I. General information

NPI: 1154014405
Provider Name (Legal Business Name): KIDS UNLIMITED LEARNING ACADEMY OF SILOAM SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N PATRIOT
SILOAM SPRINGS AR
72761-2103
US

IV. Provider business mailing address

3127 SOUTHWEST DR STE A
JONESBORO AR
72404-8404
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-8100
  • Fax:
Mailing address:
  • Phone: 870-336-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHELLY KELLER
Title or Position: CEO
Credential: MCD, CCC-SLP
Phone: 870-336-8100