Provider Demographics
NPI:1073704516
Name:IN-SYNC PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:IN-SYNC PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:479-474-6444
Mailing Address - Street 1:1109 FAYETTEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956
Mailing Address - Country:US
Mailing Address - Phone:479-474-6444
Mailing Address - Fax:479-474-6446
Practice Address - Street 1:1109 FAYETTEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956
Practice Address - Country:US
Practice Address - Phone:479-474-6444
Practice Address - Fax:479-474-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center