Healthcare Provider Details

I. General information

NPI: 1730734476
Provider Name (Legal Business Name): KIDSPOT TRUMANN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HIGHWAY 463 N
TRUMANN AR
72472-3505
US

IV. Provider business mailing address

1801 GRANT AVE
JONESBORO AR
72401-6155
US

V. Phone/Fax

Practice location:
  • Phone: 870-418-0794
  • Fax: 870-418-0791
Mailing address:
  • Phone: 870-974-9114
  • Fax: 870-974-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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