Provider Demographics
NPI:1164562716
Name:PEDIATRIC THERAPY OF NORTH CENTRAL ARKANSAS
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY OF NORTH CENTRAL ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-307-5553
Mailing Address - Street 1:990 GILL RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7857
Mailing Address - Country:US
Mailing Address - Phone:870-307-5553
Mailing Address - Fax:870-793-1936
Practice Address - Street 1:990 GILL RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7857
Practice Address - Country:US
Practice Address - Phone:870-307-5553
Practice Address - Fax:870-793-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR852225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C570Medicare UPIN