Healthcare Provider Details

I. General information

NPI: 1841389301
Provider Name (Legal Business Name): EAVES-TAYLOR THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 LAFITE LN
FAYETTEVILLE AR
72703-9808
US

IV. Provider business mailing address

1389 LAFITE LN
FAYETTEVILLE AR
72703-9808
US

V. Phone/Fax

Practice location:
  • Phone: 501-351-2301
  • Fax: 501-325-0678
Mailing address:
  • Phone: 501-351-2301
  • Fax: 501-325-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#1277
License Number StateAR

VIII. Authorized Official

Name: LAURA TAYLOR
Title or Position: OWNER
Credential: CCC
Phone: 501-351-2301