Provider Demographics
NPI:1336336122
Name:KIDS FOR THE FUTURE OF MARION
Entity Type:Organization
Organization Name:KIDS FOR THE FUTURE OF MARION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:870-739-2737
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-0148
Mailing Address - Country:US
Mailing Address - Phone:870-739-2737
Mailing Address - Fax:870-739-4337
Practice Address - Street 1:383 HIGHWAY 77 NORTH
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-0148
Practice Address - Country:US
Practice Address - Phone:870-739-2737
Practice Address - Fax:870-739-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR56191222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty