MEDICARE: ALL ABOARD PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1760622047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL ABOARD PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	3747 W MAHOGANY DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-7079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 WILLOW CREEK DR
Second Line	:	SUITE 101
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-0876
Country	:	US
Telephone Number	:	501-412-6384
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	ASHLEY HAGLER
Credential	:
Telephone Number	:	501-412-6384

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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Directions to “ALL ABOARD PEDIATRIC THERAPY ” Practice Location

Language	Start Address	Practice Location

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