Healthcare Provider Details

I. General information

NPI: 1124758586
Provider Name (Legal Business Name): EQUINOVATE THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9288 MARS HILL RD
BAUXITE AR
72011-8024
US

IV. Provider business mailing address

9288 MARS HILL RD
BAUXITE AR
72011-8024
US

V. Phone/Fax

Practice location:
  • Phone: 502-849-8644
  • Fax:
Mailing address:
  • Phone: 501-849-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: SARA HICKS
Title or Position: THERAPIST
Credential: COTA/L
Phone: 501-849-8644