Provider Demographics
NPI:1235561838
Name:QUALLS THERAPY SERVICES INC
Entity Type:Organization
Organization Name:QUALLS THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:870-307-4736
Mailing Address - Street 1:169 RAINBOW LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-9815
Mailing Address - Country:US
Mailing Address - Phone:870-307-4736
Mailing Address - Fax:870-283-6304
Practice Address - Street 1:169 RAINBOW LN
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-9815
Practice Address - Country:US
Practice Address - Phone:870-307-4736
Practice Address - Fax:870-283-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197907742Medicaid