Provider Demographics
NPI:1740808591
Name:RAES OF SUNSHINE THERAPY SERVICES
Entity type:Organization
Organization Name:RAES OF SUNSHINE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERMA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:501-831-5159
Mailing Address - Street 1:127 R G DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:ROMANCE
Mailing Address - State:AR
Mailing Address - Zip Code:72136-7005
Mailing Address - Country:US
Mailing Address - Phone:501-831-5159
Mailing Address - Fax:
Practice Address - Street 1:127 R G DAVIS RD
Practice Address - Street 2:
Practice Address - City:ROMANCE
Practice Address - State:AR
Practice Address - Zip Code:72136-7005
Practice Address - Country:US
Practice Address - Phone:501-831-5159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty