Provider Demographics
NPI:1710155536
Name:OCCUPATIONAL PROFESSIONAL SEVICES INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL PROFESSIONAL SEVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:501-350-0819
Mailing Address - Street 1:509 NORTH VALENTINE ST.
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4135
Mailing Address - Country:US
Mailing Address - Phone:501-350-0819
Mailing Address - Fax:501-747-1535
Practice Address - Street 1:509 NORTH VALENTINE ST.
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4135
Practice Address - Country:US
Practice Address - Phone:501-350-0819
Practice Address - Fax:501-747-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR363332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168935716Medicaid
AR121955721Medicaid
AR130683742Medicaid
AR0647980001Medicare NSC