Provider Demographics
NPI: | 1942841614 |
---|---|
Name: | CROUCH THERAPY SERVICES LLC |
Entity Type: | Organization |
Organization Name: | CROUCH THERAPY SERVICES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIMBERLY |
Authorized Official - Middle Name: | NICOLE |
Authorized Official - Last Name: | CROUCH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | COTA/L |
Authorized Official - Phone: | 870-307-5688 |
Mailing Address - Street 1: | 240 DALTON LN |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWARK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72562-9400 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 870-307-5688 |
Mailing Address - Fax: | 870-569-8006 |
Practice Address - Street 1: | 240 DALTON LN |
Practice Address - Street 2: | |
Practice Address - City: | NEWARK |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72562-9400 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-307-5688 |
Practice Address - Fax: | 870-569-8006 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-03 |
Last Update Date: | 2019-10-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty |