Provider Demographics
NPI: | 1518314368 |
---|---|
Name: | ARKANSAS THERAPY OUTREACH |
Entity Type: | Organization |
Organization Name: | ARKANSAS THERAPY OUTREACH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH LANGUAGE PATHOLOGIST |
Authorized Official - Prefix: | MISS |
Authorized Official - First Name: | TAYLOR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS CCC SLP |
Authorized Official - Phone: | 501-520-8220 |
Mailing Address - Street 1: | 22461 I 30 |
Mailing Address - Street 2: | SUITE 1100A |
Mailing Address - City: | BRYANT |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72022-2364 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-481-8930 |
Mailing Address - Fax: | 501-481-8914 |
Practice Address - Street 1: | 600 MAIN ST |
Practice Address - Street 2: | SUITE P |
Practice Address - City: | HOT SPRINGS |
Practice Address - State: | AR |
Practice Address - Zip Code: | 71913-4905 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-463-9533 |
Practice Address - Fax: | 501-463-9536 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-05-23 |
Last Update Date: | 2016-05-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |