Provider Demographics
NPI:1174681910
Name:OZARKS OCCUPATIONAL THERAPY INC
Entity Type:Organization
Organization Name:OZARKS OCCUPATIONAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MOTZKO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:870-480-9085
Mailing Address - Street 1:1401 VICKIE CIR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-5202
Mailing Address - Country:US
Mailing Address - Phone:870-480-9085
Mailing Address - Fax:870-480-9085
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN FOREST
Practice Address - State:AR
Practice Address - Zip Code:72638-2316
Practice Address - Country:US
Practice Address - Phone:870-480-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139703742Medicaid