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General NPI Number Information
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NPI Number | 1265871248
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Entity Type | Organization
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Legal Business Name | KIDSPIRATION PEDIATRIC THERAPY SERVICES TOO, INC.
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Dates
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Enumeration Date | 06/23/2013
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Last Update Date | 06/23/2013
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Provider Practice Location Address
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Address Line | 905 EAST MAIN ST
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City | MELBOURNE
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State | AR
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Zip | 72556
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Country | US
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Telephone | 870-368-4586
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Fax | 870-368-4587
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Provider Business Mailing Address
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Address Line | PO BOX 2533
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-2533
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Country | US
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Telephone | 870-368-4586
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Fax | 870-368-4587
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | REGAN THARP
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Credential |
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Telephone | 870-710-1336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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