Organization
MIRACLE KIDS SUCCESS ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY DECKER (CEO)
(870) 932-2600
Entity
Organization
Contact information
Practice address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-2600
(870) 932-3611
Mailing address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-2600
(870) 932-3611
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181713742
—
AR
Enumeration date
06/17/2010
Last updated
11/30/2020
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