Provider Demographics
NPI:1437642311
Name:RANCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:RANCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:479-651-4098
Mailing Address - Street 1:PO BOX 7496
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-0382
Mailing Address - Country:US
Mailing Address - Phone:479-651-4098
Mailing Address - Fax:479-208-4048
Practice Address - Street 1:2221 E POINTER TRL
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2336
Practice Address - Country:US
Practice Address - Phone:479-651-4098
Practice Address - Fax:479-208-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty