Provider Demographics
NPI:1407862253
Name:CORNERSTONE KIDS THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:CORNERSTONE KIDS THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:870-793-1925
Mailing Address - Street 1:1515 HARRISON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7222
Mailing Address - Country:US
Mailing Address - Phone:870-793-1925
Mailing Address - Fax:
Practice Address - Street 1:1515 HARRISON ST STE B
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7222
Practice Address - Country:US
Practice Address - Phone:870-793-1925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7227677OtherAETNA
AR5F161OtherARKANSAS BLUE CROSS