Organization
STAR PEDIATRIC THERAPY LLC
Active
Other names
Star Pediatric Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY SIMPSON (OWNER)
(479) 301-2614
Entity
Organization
Contact information
Practice address
82 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 301-2614
(479) 301-2615
Mailing address
82 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1822
(479) 301-2614
(479) 301-2615
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2659
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226788742
—
AR
Enumeration date
08/02/2018
Last updated
08/02/2018
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