| NPI | 1639641293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI NICOLE WILKES Office Manager 870-919-1978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225700000X Massage Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2019-06-11 |