Healthcare Provider Details

I. General information

NPI: 1750711743
Provider Name (Legal Business Name): OZARK SHOULDER TO HAND CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W 6TH ST OZARK SHOULDER TO HAND CENTER
MOUNTAIN HOME AR
72653-3421
US

IV. Provider business mailing address

PO BOX 430
MOUNTAIN HOME AR
72654-0430
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-2224
  • Fax: 870-424-0493
Mailing address:
  • Phone: 870-424-2224
  • Fax: 870-424-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR1340
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTR1340
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTR1340
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1340
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1340
License Number StateAR

VIII. Authorized Official

Name: CRYSTAL D HENRY
Title or Position: MANAGING MEMBER
Credential: OTR/L,CHT
Phone: 870-421-6937