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Organization
STAR PEDIATRIC THERAPY LLC
Active
Organization
STAR PEDIATRIC THERAPY LLC
Active
Other names
Star Pediatric Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY SIMPSON (OWNER)
(479) 301-2614
Entity
Organization
Contact information
Practice address
82 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 301-2614
(479) 301-2615
Mailing address
82 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 301-2614
(479) 301-2615
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2659
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226788742
—
AR
Enumeration date
08/02/2018
Last updated
08/02/2018
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