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?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty