Active NPI
Lewis Tyler Harrell
- Occupational Therapy Assistant
- Trumann, AR
National Provider Identifier
1093534133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OT-A1704
- Practice address
- Miracle Kids Success Acadmey
1005 Balcom Lane
Trumann, AR 72472 - Phone
- (870) 418-1000
- NPI assigned
- Oct 7, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OT-A1704 | AR | Primary |
Addresses
Primary practice location
Miracle Kids Success Acadmey
1005 Balcom Lane
Trumann, AR 72472
Mailing address
Miracle Kids Success Academy
3127 Southwest Dr
Jonesboro, AR 72404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-A1704 | AR | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1093534133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MIRACLE KIDS SUCCESS ACADEMY",
"address_2": "3127 SOUTHWEST DR",
"city": "JONESBORO",
"state": "AR",
"postal_code": "72404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MIRACLE KIDS SUCCESS ACADMEY",
"address_2": "1005 BALCOM LANE",
"city": "TRUMANN",
"state": "AR",
"postal_code": "72472",
"telephone_number": "870-418-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRELL",
"first_name": "LEWIS",
"middle_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-07",
"certification_date": "2024-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OT-A1704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trumann, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.