Provider Demographics
NPI:1770649956
Name:LEAPS AND BOUNDS PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:LEAPS AND BOUNDS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:501-730-0742
Mailing Address - Street 1:3060 DALLAS LOOP
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8123
Mailing Address - Country:US
Mailing Address - Phone:501-730-0742
Mailing Address - Fax:501-730-0742
Practice Address - Street 1:3060 DALLAS LOOP
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8123
Practice Address - Country:US
Practice Address - Phone:501-730-0742
Practice Address - Fax:501-730-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W518OtherBCBS SUBMITTER ID