STACIE MICHELLE CORNWELL (NPI# 1255868774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255868774 |
| Entity Type | Individual |
| Full Name | STACIE MICHELLE CORNWELL |
| Credential | MSED |
| Practice Address |
1306 Military Rd Ste 1 Benton AR 72015-2732 |
| Mailing Address |
2915 Saint Andrews Dr Benton AR 72019-6874 |
| Practice Telephone | 5014818930 |
| Practice Fax Number | 5014084699 |
| Mailing Telephone | 5014818930 |
| Mailing Fax Number | 5014084699 |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2017-05-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Q00000X | Developmental Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1306 MILITARY RD STE 1 |
| City | BENTON |
| State | AR |
| Zip Code | 72015-2732 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003341900 | Taralee Reeves | Occupational Therapist | 1306 Military Rd Ste 1, Benton, AR 72015-2732 | 2017-04-28 |
| 1922508613 | Elizabeth Clark | Physical Therapist | 1306 Military Rd Ste 1, Benton, AR 72015-2732 | 2018-02-19 |
| 1760997498 | Jessica Lee Forthman | Specialist/Technologist | 1306 Military Rd Ste 1, Benton, AR 72015-2732 | 2017-12-04 |
| 1568986248 | Arkansas Therapy Outreach, LLC | Clinic/Center | 1306 Military Rd Ste 1, Benton, AR 72015-2732 | 2017-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790343135 | Justin King | Case Manager/Care Coordinator | 1502 Mary Kay Blv6, Benton, AR 72015 | 2019-05-31 |
| 1790253326 | Seth Alexander Weisheit | Nurse Practitioner | 824 Military Road, Benton, AR 72015 | 2018-11-13 |
| 1396269627 | Abby G Sims | Speech-Language Pathologist | 3391 Peachtree Lane, Benton, AR 72015 | 2017-07-28 |
| 1225551278 | Jessica R Poe | Case Manager/Care Coordinator | 1502 Marykay Blvd, Benton, AR 72015 | 2017-07-21 |
| 1003357997 | Jamaal Langston | Case Manager/Care Coordinator | 1502 Mark Kay Blvd, Benton, AR 72015 | 2017-03-13 |
| 1881138550 | Shannon Gachot-ridgley | Counselor | 205 South Street Suite 3, Benton, AR 72015 | 2016-12-14 |
| 1295104578 | Excel Health of Haskell, Pllc | Clinical Nurse Specialist | 6029 Us Hwy 67, Haskell, AR 72015 | 2015-09-17 |
| 1528464054 | Kacey Jo Kiker | Nurse Practitioner | 620 W South St, Benton, AR 72015 | 2014-11-11 |
| 1700218252 | Jamie Brunt | Licensed Practical Nurse | 1718 Old Hot Springs Rd, Benton, AR 72015 | 2013-08-07 |
| 1760738942 | Kari J Richards | Physical Therapist | 5701 Springhill Rd, Bryant, AR 72015 | 2012-07-25 |
| Find all providers in zip 72015 | ||||
| Taxonomy Code | 222Q00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Developmental Therapist |
| A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development. |
| Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154680437 | Jillian Renee Carpenter | Developmental Therapist | 401 W 6th St, Benton, IL 62812-1247 | 2012-05-08 |
| 1164656583 | Patricia A. Slater | Developmental Therapist | 221 Benton Neck Rd., Benton, ME 04901 | 2009-05-13 |
| 1922456102 | Elissa Locker | Developmental Therapist | 114 Greenwood Pl, Benton, KY 42025-7640 | 2016-05-29 |
| 1174978936 | Misty Lawson | Developmental Therapist | 114 Greenwood Pl, Benton, KY 42025-7640 | 2016-04-29 |
| 1205211844 | Sharon Powell | Developmental Therapist | 610 Hwy 5 N, Benton, AR 72019-8559 | 2015-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396379897 | Allison Nicole Davis | Developmental Therapist | 104 Hope St, Hoxie, AR 72433-9014 | 2020-02-24 |
| 1174161707 | Anna Shrum | Developmental Therapist | 721 Alford Street, Flippin, AR 72634 | 2019-12-13 |
| 1033752290 | Krista Crainer | Developmental Therapist | 4701 N Carbon City Rd, Ozark, AR 72949 | 2019-10-21 |
| 1063061216 | Dawn Renae Burnett | Developmental Therapist | 2001 E Kiehl Ave Ste 12, Sherwood, AR 72120-3123 | 2019-09-10 |
| 1972165827 | Heather Marie Box | Developmental Therapist | 344 Fayetteville Ave, Alma, AR 72921-3655 | 2019-07-01 |
| 1861954950 | Darnise Lashelle Price | Developmental Therapist | 18 Woodbriar Dr, Jacksonville, AR 72076-5365 | 2019-04-05 |
| 1164984373 | Keys (keeping Every Youth Safe) | Developmental Therapist | 2717 So Ringo Street, Little Rock, AR 72206-6554 | 2019-04-05 |
| 1194215350 | Amy Carol Yetley | Developmental Therapist | 8 Van Lee Dr, Little Rock, AR 72205-2452 | 2018-05-14 |
| 1447759782 | Lashauna Walton | Developmental Therapist | 129 Harvick Cir, Cabot, AR 72023-7107 | 2018-02-01 |
| 1780102210 | Janet Karen Watkins | Developmental Therapist | 1810 Ozarka College Drive, Mountain View, AR 72560 | 2017-09-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.