Provider Demographics
NPI:1003107434
Name:ARKANSAS THERAPY OUTREACH, LLC
Entity Type:Organization
Organization Name:ARKANSAS THERAPY OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:501-350-7572
Mailing Address - Street 1:3851 LEGACY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-9745
Mailing Address - Country:US
Mailing Address - Phone:501-350-7572
Mailing Address - Fax:501-776-4059
Practice Address - Street 1:3851 LEGACY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-9745
Practice Address - Country:US
Practice Address - Phone:501-350-7572
Practice Address - Fax:501-776-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty