Provider Demographics
NPI:1508352485
Name:KIDSPIRATION PEDIATRIC THERAPY SERVICES TOO, INC.
Entity Type:Organization
Organization Name:KIDSPIRATION PEDIATRIC THERAPY SERVICES TOO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-368-4586
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0967
Mailing Address - Country:US
Mailing Address - Phone:870-368-4586
Mailing Address - Fax:
Practice Address - Street 1:889 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8205
Practice Address - Country:US
Practice Address - Phone:870-368-4586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDSPIRATION PEDIATRIC THERAPY SERVICES TOO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR226010742Medicaid