Individual
LEWIS TYLER HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
MIRACLE KIDS SUCCESS ACADMEY, 1005 BALCOM LANE, TRUMANN, AR 72472
(870) 418-1000
Mailing address
MIRACLE KIDS SUCCESS ACADEMY, 3127 SOUTHWEST DR, JONESBORO, AR 72404
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1704
AR
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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