MEDICARE: KAY SHORE OT

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	225X00000X	Occupational Therapist	OTR2053	AR

General Provider Information

NPI Number	:	1205839628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY SHORE OT

Provider Business Mailing Address
First Line	:	170 RUSHFORK CIR
Second Line	:
City	:	HOT SPRINGS NATIONAL PARK
State	:	AR
Zip	:	71913-8576
Country	:	US
Telephone Number	:	501-538-4546
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 RUSHFORK CIR
Second Line	:
City	:	HOT SPRINGS NATIONAL PARK
State	:	AR
Zip	:	71913-8576
Country	:	US
Telephone Number	:	501-538-4546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/21/2026

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