Healthcare Provider Details

I. General information

NPI: 1881738409
Provider Name (Legal Business Name): MCT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10618 BRECKENRIDGE DR
LITTLE ROCK AR
72211-1802
US

IV. Provider business mailing address

10618 BRECKENRIDGE DR
LITTLE ROCK AR
72211-1802
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-8600
  • Fax: 501-217-8636
Mailing address:
  • Phone: 501-217-8600
  • Fax: 501-217-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number98-19P
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateAR
# 8
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateAR
# 9
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name: SHALENE S. HAMMONS
Title or Position: ADMINISTRATIVE EXECUTIVE ASSISTANT
Credential:
Phone: 501-217-8600