Provider Demographics
NPI:1669913257
Name:THERAPY FOR LIFE, LLC
Entity type:Organization
Organization Name:THERAPY FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-404-7736
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0353
Mailing Address - Country:US
Mailing Address - Phone:870-404-7736
Mailing Address - Fax:
Practice Address - Street 1:9460 HWY 62 E
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634
Practice Address - Country:US
Practice Address - Phone:870-404-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty