NPIMap

Organization Active NPI

Kids Unlimited of Washington Coutny, Inc.

  • Occupational Therapist
  • Farmington, AR
National Provider Identifier
1871932319
Registry record updated Dec 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
KIDS UNLIMITED OF WASHINGTON COUTNY, INC.
Practice address
120 Southwinds Rd Ste 2
Farmington, AR 72730-8652
Phone
(479) 300-6400
NPI assigned
Jun 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 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

120 Southwinds Rd Ste 2
Farmington, AR 72730-8652

Mailing address

120 Southwinds Rd Ste 2
Farmington, AR 72730-8652
Phone (479) 300-6400

Other identifiers 1

IdentifierTypeStateIssuer
200897742MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Kids Unlimited of Washington County Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1871932319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 SOUTHWINDS RD STE 2",
            "city": "FARMINGTON",
            "state": "AR",
            "postal_code": "727308652",
            "telephone_number": "479-300-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SOUTHWINDS RD STE 2",
            "city": "FARMINGTON",
            "state": "AR",
            "postal_code": "727308652",
            "telephone_number": "479-300-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS UNLIMITED OF WASHINGTON COUTNY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-18",
        "last_updated": "2014-12-29",
        "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": "200897742",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.