Provider Demographics
NPI:1629356027
Name:PEARSON PEDIATRIC OT SERVICES
Entity Type:Organization
Organization Name:PEARSON PEDIATRIC OT SERVICES
Other - Org Name:TEXARKANA THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAULSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-793-6135
Mailing Address - Street 1:3718 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3566
Mailing Address - Country:US
Mailing Address - Phone:903-793-6135
Mailing Address - Fax:903-793-0053
Practice Address - Street 1:3718 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3566
Practice Address - Country:US
Practice Address - Phone:903-793-6135
Practice Address - Fax:903-793-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037620OtherUNITED HEALTHCARE
AR5G636OtherBCBS AR
AR189105742Medicaid
TX0032XHOtherBCBS TX
TX004487701Medicaid
TX004487702Medicaid
TX1257420OtherAMERICAN SPECIALTY HEATH CIGNA