Basic Information
| Provider Information | |||||||||
| NPI: | 1316176878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALTY PEDIATRIC AND AUTISM RESOURCE CLINIC OF ARKANSAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 STONE ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709314200 | ||||||||
| FaxNumber: | 8709314201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 STONE ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709314200 | ||||||||
| FaxNumber: | 8709314201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2009 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | PATE | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE CLERK | ||||||||
| AuthorizedOfficialTelephone: | 8709314200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.