Provider Demographics
NPI:1992831234
Name:THERAPY 4 KIDS
Entity Type:Organization
Organization Name:THERAPY 4 KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:501-581-6045
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0933
Mailing Address - Country:US
Mailing Address - Phone:501-581-6045
Mailing Address - Fax:
Practice Address - Street 1:92 SOUTH BROADVIEW
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058
Practice Address - Country:US
Practice Address - Phone:501-581-6045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F655OtherBLUE CROSS
AR160654742Medicaid