Healthcare Provider Details

I. General information

NPI: 1174681910
Provider Name (Legal Business Name): OZARKS OCCUPATIONAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAIN ST
GREEN FOREST AR
72638-2316
US

IV. Provider business mailing address

1401 VICKIE CIR
BERRYVILLE AR
72616-5202
US

V. Phone/Fax

Practice location:
  • Phone: 870-480-9085
  • Fax:
Mailing address:
  • Phone: 870-480-9085
  • Fax: 870-480-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR973
License Number StateAR

VIII. Authorized Official

Name: MRS. LEAH CAROL MOTZKO
Title or Position: SECRETARY
Credential: OTR
Phone: 870-480-9085