Provider Demographics
NPI:1568864916
Name:EASTER SEALS ARKANSAS
Entity Type:Organization
Organization Name:EASTER SEALS ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAMERAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:870-821-1571
Mailing Address - Street 1:5 BEAR TRAIL CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-8787
Mailing Address - Country:US
Mailing Address - Phone:870-821-1571
Mailing Address - Fax:
Practice Address - Street 1:3920 WOODLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2495
Practice Address - Country:US
Practice Address - Phone:501-227-3600
Practice Address - Fax:501-227-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2732261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities