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General NPI Number Information
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NPI Number | 1568959179
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Entity Type | Organization
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Legal Business Name | KIDDOS THERAPY
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 7411 ELLIS ST STE 200
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City | FORT SMITH
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State | AR
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Zip | 72916-6106
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Country | US
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Telephone | 479-242-3414
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Fax | 479-242-3415
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Provider Business Mailing Address
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Address Line | 7411 ELLIS ST STE 200
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City | FORT SMITH
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State | AR
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Zip | 72916-6106
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Country | US
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Telephone | 479-242-3414
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Fax | 479-242-3415
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | JODI CABANESS
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Credential | PT
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Telephone | 479-970-8351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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