Provider Demographics
NPI:1598414419
Name:DUROCHER THERAPY SERVICES
Entity Type:Organization
Organization Name:DUROCHER THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUROCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:501-467-4995
Mailing Address - Street 1:500 AMITY RD STE 5B-295
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5965
Mailing Address - Country:US
Mailing Address - Phone:501-467-4995
Mailing Address - Fax:
Practice Address - Street 1:500 AMITY RD STE 5B-295
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5965
Practice Address - Country:US
Practice Address - Phone:501-467-4995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1598414419Medicaid