Provider Demographics
NPI:1184850075
Name:OZARK THERAPY INSTITUTE, LLC
Entity Type:Organization
Organization Name:OZARK THERAPY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-881-9500
Mailing Address - Street 1:4560 S CAMPBELL AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1720
Mailing Address - Country:US
Mailing Address - Phone:417-881-9500
Mailing Address - Fax:417-881-9502
Practice Address - Street 1:4560 S CAMPBELL AVE
Practice Address - Street 2:SUITE N
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1720
Practice Address - Country:US
Practice Address - Phone:417-881-9500
Practice Address - Fax:417-881-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty