Provider Demographics
NPI:1568959179
Name:KIDDOS THERAPY
Entity type:Organization
Organization Name:KIDDOS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:CABANESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-970-8351
Mailing Address - Street 1:7411 ELLIS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-6106
Mailing Address - Country:US
Mailing Address - Phone:479-242-3414
Mailing Address - Fax:479-242-3415
Practice Address - Street 1:7411 ELLIS ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6106
Practice Address - Country:US
Practice Address - Phone:479-242-3414
Practice Address - Fax:479-242-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy