Basic Information
| Provider Information | |||||||||
| NPI: | 1316592801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABOVE AND BEYOND PEDIATRIC THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 AMERICAN ST. | ||||||||
| Address2: | STE B | ||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705885860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2700 AMERICAN ST. | ||||||||
| Address2: | STE B | ||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705885860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | DOAN | ||||||||
| AuthorizedOfficialFirstName: | ALLISON | ||||||||
| AuthorizedOfficialMiddleName: | PRIBBLE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT-OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8705885860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225XP0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.