NPIMap

Organization Active NPI

Kids Unlimited Learning Academy

  • Occupational Therapist
  • Cabot, AR
National Provider Identifier
1629418934
Registry record updated Aug 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
KIDS UNLIMITED LEARNING ACADEMY
Practice address
2792 S 2ND St
Suites B & C
Cabot, AR 72023-7020
Phone
(870) 761-6680
NPI assigned
Jul 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2014

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

Authorized official

Name
Shelly Decker, MCD, CCC-SLP
Title
Ceo
Phone
(870) 761-6680

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

2792 S 2ND St
Suites B & C
Cabot, AR 72023-7020

Mailing address

1901 Pine Valley LN
Jonesboro, AR 72404-8435
Phone (870) 761-6680

Other identifiers 1

IdentifierTypeStateIssuer
199934742MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Kids Unlimited Learning Academy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3148 Highway 367 S
Cabot, AR 72023
Phone (501) 268-3400

2792 S 2nd St
Ste B
Cabot, AR 72023
Phone (501) 729-6300

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1629418934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 PINE VALLEY LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724048435",
            "telephone_number": "870-761-6680",
            "fax_number": "501-246-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2792 S 2ND ST",
            "address_2": "SUITES B & C",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720237020",
            "telephone_number": "870-761-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS UNLIMITED LEARNING ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-01",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-761-6680",
        "authorized_official_credential": "MCD, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199934742",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cabot, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; 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.