Provider Demographics
NPI:1346419074
Name:OCCUPATIONAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MCDCCC-SLP
Authorized Official - Phone:870-336-0021
Mailing Address - Street 1:3423 E HIGHLAND DR STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6490
Mailing Address - Country:US
Mailing Address - Phone:870-336-0021
Mailing Address - Fax:870-336-0022
Practice Address - Street 1:3423 E HIGHLAND DR STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6490
Practice Address - Country:US
Practice Address - Phone:870-336-0021
Practice Address - Fax:870-336-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty