Provider Demographics
NPI:1891988820
Name:MITCHELLE THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:MITCHELLE THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OT/L
Authorized Official - Phone:479-462-3177
Mailing Address - Street 1:1905 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-7957
Mailing Address - Country:US
Mailing Address - Phone:479-462-3177
Mailing Address - Fax:479-474-6446
Practice Address - Street 1:1905 EDWARDS RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-7957
Practice Address - Country:US
Practice Address - Phone:479-462-3177
Practice Address - Fax:479-474-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0717261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center