Organization
KIDZ KAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLEY D LEWIS OTRL (ADMINISTRATOR)
(501) 230-3100
Entity
Organization
Contact information
Practice address
27 HIGHWAY 64 WEST, BEEBE, AR 72012-2094
(501) 230-3100
(501) 882-9825
Mailing address
130 UNDERHILL RD, BEEBE, AR 72012-9751
(501) 230-3100
(501) 882-2801
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156889742
—
AR
Enumeration date
05/03/2007
Last updated
05/14/2009
Update your record
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