Organization
MIRACLE KIDS SUCCESS ACADEMY OF TRUMANN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY KELLER MCD, CCC-SLP (CEO)
(870) 761-6680
Entity
Organization
Contact information
Practice address
1005 BALCOM LN, TRUMANN, AR 72472-9502
(870) 761-6680
Mailing address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-3600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
02/25/2019
Last updated
02/25/2019
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