Healthcare Provider Details

I. General information

NPI: 1487925897
Provider Name (Legal Business Name): EBONY L RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CIR
NASHVILLE AR
71852-8606
US

IV. Provider business mailing address

1312 MYRNA LN
NORTH LITTLE ROCK AR
72117-9746
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-4400
  • Fax:
Mailing address:
  • Phone: 501-240-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTR2245
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: