Provider Demographics
NPI:1851016547
Name:MOTOR MOUTH PEDIATRIC THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MOTOR MOUTH PEDIATRIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:479-675-6224
Mailing Address - Street 1:9401 N STATE HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:MAGAZINE
Mailing Address - State:AR
Mailing Address - Zip Code:72943-8443
Mailing Address - Country:US
Mailing Address - Phone:479-675-6224
Mailing Address - Fax:
Practice Address - Street 1:307 PENNINGTON DR STE A
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-3747
Practice Address - Country:US
Practice Address - Phone:479-675-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty