MEDICARE: HEAVENLY THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1023715208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	8103 BEAR HOLLOW RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-7416
Country	:	US
Telephone Number	:	479-650-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	8103 BEAR HOLLOW RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-7416
Country	:	US
Telephone Number	:	479-650-2466
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	ANGELA FISHER
Credential	:	OTR/L
Telephone Number	:	479-650-2466

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	08/23/2023

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Directions to “HEAVENLY THERAPY SERVICES, LLC ” Practice Location

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