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General NPI Number Information
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NPI Number | 1508352485
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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 | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 889 MAIN ST
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City | MELBOURNE
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State | AR
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Zip | 72556-8205
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Country | US
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Telephone | 870-368-4586
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | MELBOURNE
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State | AR
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Zip | 72556-0967
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Country | US
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Telephone | 870-368-4586
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Fax |
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Authorized Official
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Title or Position | BILLING MGR
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Name | MRS. CHARLOTTE CLAXTON
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Credential |
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Telephone | 870-368-4586
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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 | AR
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