Healthcare Provider Details

I. General information

NPI: 1154059251
Provider Name (Legal Business Name): SPROUTS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 PHOENIX AVE STE A
FORT SMITH AR
72901-7939
US

IV. Provider business mailing address

1821 PHOENIX AVE STE A
FORT SMITH AR
72901-7939
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-1924
  • Fax: 479-358-1455
Mailing address:
  • Phone: 479-222-1924
  • Fax: 479-358-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA RAE SMITH
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 501-772-1461