Provider Demographics
NPI:1497572606
Name:MAGNOLIA TREE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:MAGNOLIA TREE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEATS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:870-656-9933
Mailing Address - Street 1:2397 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-7282
Mailing Address - Country:US
Mailing Address - Phone:870-656-9933
Mailing Address - Fax:
Practice Address - Street 1:81 DEVELOPMENT DR
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687-7039
Practice Address - Country:US
Practice Address - Phone:870-232-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty