Provider Demographics
NPI:1689164485
Name:OT FOR KIDS
Entity Type:Organization
Organization Name:OT FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:SCROGGINS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:870-213-5286
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-0016
Mailing Address - Country:US
Mailing Address - Phone:870-213-5286
Mailing Address - Fax:870-269-2840
Practice Address - Street 1:201 ELEMENTARY ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6287
Practice Address - Country:US
Practice Address - Phone:870-213-5286
Practice Address - Fax:870-269-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty