Healthcare Provider Details

I. General information

NPI: 1689385890
Provider Name (Legal Business Name): KIDSPOT TRUMANN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 HIGHWAY 463 N
TRUMANN AR
72472-1636
US

IV. Provider business mailing address

831 HIGHWAY 463 N
TRUMANN AR
72472-1636
US

V. Phone/Fax

Practice location:
  • Phone: 870-418-0794
  • Fax: 870-418-0791
Mailing address:
  • Phone: 870-418-0794
  • Fax: 870-418-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GINA DEUTER
Title or Position: OWNER
Credential:
Phone: 870-974-9114