Provider Demographics
NPI:1346634953
Name:FOX-TROT THERAPY SERVICES
Entity Type:Organization
Organization Name:FOX-TROT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:870-671-4871
Mailing Address - Street 1:2003 UNIVERSITY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-2463
Mailing Address - Country:US
Mailing Address - Phone:870-671-4871
Mailing Address - Fax:870-671-4872
Practice Address - Street 1:2003 UNIVERSITY DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-2463
Practice Address - Country:US
Practice Address - Phone:870-671-4871
Practice Address - Fax:870-671-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14-01502355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty