Provider Demographics
NPI:1205370681
Name:SPOT ON PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:SPOT ON PEDIATRIC THERAPY, LLC
Other - Org Name:SYDNEY GRISWOLD
Other - Org Type:Other Name
Authorized Official - Title/Position:INCORPORATOR/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:870-688-6140
Mailing Address - Street 1:1909 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-9210
Mailing Address - Country:US
Mailing Address - Phone:870-204-5330
Mailing Address - Fax:
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2900
Practice Address - Country:US
Practice Address - Phone:870-204-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2149225X00000X
ARSP#3747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205115721Medicaid
AR166329721Medicaid