Provider Demographics
NPI:1750711743
Name:OZARK SHOULDER TO HAND CENTER LLC
Entity type:Organization
Organization Name:OZARK SHOULDER TO HAND CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L,CHT
Authorized Official - Phone:870-421-6937
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0430
Mailing Address - Country:US
Mailing Address - Phone:870-424-2224
Mailing Address - Fax:870-424-0493
Practice Address - Street 1:715 W 6TH ST
Practice Address - Street 2:OZARK SHOULDER TO HAND CENTER
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3421
Practice Address - Country:US
Practice Address - Phone:870-424-2224
Practice Address - Fax:870-424-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1340225XH1200X, 225XN1300X, 225XP0019X, 225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty