Healthcare Provider Details

I. General information

NPI: 1255485827
Provider Name (Legal Business Name): ASCENT AQUISITION CORP- PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 PINE ST
ARKADELPHIA AR
71923-4335
US

IV. Provider business mailing address

399 WYLDEWOOD DR
GURDON AR
71743-9089
US

V. Phone/Fax

Practice location:
  • Phone: 870-245-2210
  • Fax:
Mailing address:
  • Phone: 870-353-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-334
License Number StateAR

VIII. Authorized Official

Name: LINDA LEAMONS
Title or Position: COTA
Credential:
Phone: 870-245-2210