Healthcare Provider Details

I. General information

NPI: 1942314893
Provider Name (Legal Business Name): OCCUPATIONAL THERAPY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MAIN ST.
LAKE VILLAGE AR
71653
US

IV. Provider business mailing address

316 MAIN ST.
LAKE VILLAGE AR
71653
US

V. Phone/Fax

Practice location:
  • Phone: 870-265-3950
  • Fax: 870-265-2525
Mailing address:
  • Phone: 870-265-3950
  • Fax: 870-265-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOTR774
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP1285
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARRIE H PIERONI
Title or Position: OT/OWNER
Credential: OT
Phone: 870-265-3950