Organization
MIRACLE KIDS SUCCESS ACADEMY CENTRAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY KELLER MCD, CCC-SLP (CEO)
(870) 336-8100
Entity
Organization
Contact information
Practice address
1607 STONE ST, JONESBORO, AR 72401-5332
(870) 336-4100
(877) 769-1668
Mailing address
3127 SOUTHWEST DR STE A, JONESBORO, AR 72404-8404
(870) 336-8100
(877) 769-1668
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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