Healthcare Provider Details

I. General information

NPI: 1538575238
Provider Name (Legal Business Name): TAYLOR A COUNCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 STONE ST STE 140
JONESBORO AR
72401-4568
US

IV. Provider business mailing address

1218 STONE ST STE 140
JONESBORO AR
72401-4568
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0220
  • Fax: 870-558-5637
Mailing address:
  • Phone: 870-336-0220
  • Fax: 870-558-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA1503
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: