Healthcare Provider Details

I. General information

NPI: 1407964802
Provider Name (Legal Business Name): CROSS THERAPY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W COLT SQUARE DR
FAYETTEVILLE AR
72703-2813
US

IV. Provider business mailing address

3398 E CANTERBURY CIR
FAYETTEVILLE AR
72701-2862
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-2740
  • Fax: 479-582-2746
Mailing address:
  • Phone: 479-251-0192
  • Fax: 479-582-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR660
License Number StateAR

VIII. Authorized Official

Name: MRS. MELINDA E LUNN
Title or Position: OWNER/PRESIDENT
Credential: OTR/L
Phone: 479-582-2740