Star Pediatric Therapy LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2659 Issued in AR

Legal business name

STAR PEDIATRIC THERAPY LLC

Doing business as

Star Pediatric Therapy

Practice address

82 W Sunbridge Dr
Fayetteville, AR 72703-1822

Phone

(479) 301-2614

Fax

(479) 301-2615

NPI assigned

Aug 2, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Misty Simpson

Title

Owner

Phone

(479) 301-2614

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Star Pediatric Therapy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533168000000",
    "number": "1598243370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031822",
            "telephone_number": "479-301-2614",
            "fax_number": "479-301-2615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031822",
            "telephone_number": "479-301-2614",
            "fax_number": "479-301-2615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-02",
        "last_updated": "2018-08-02",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-301-2614"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "AR",
            "license": "2659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226788742",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Star Pediatric Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Martha Megan Staires, CPM, LLM
• Bailey Nicole Standridge
• Mandy Stanek, LAMFT/LAC
• Alexandra Stanfill
• Victoria Stanley
• Jeremy M Stark, LCSW
• Kathryn Stark, PHARMD
• Samantha Raychell Starling, ATC
• Stat Medical LLC
• Stat Veteran Wound Care Inc

• Speech-Language Pathologist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Speech-Language Pathologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.