Healthcare Provider Details

I. General information

NPI: 1437492741
Provider Name (Legal Business Name): BLOCKER THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 CROW RD
PERRYVILLE AR
72126-8235
US

IV. Provider business mailing address

46 CROW RD
PERRYVILLE AR
72126-8235
US

V. Phone/Fax

Practice location:
  • Phone: 501-215-6508
  • Fax: 800-609-2701
Mailing address:
  • Phone: 501-215-6508
  • Fax: 800-609-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA BLOCKER
Title or Position: OCCUPATIONAL THERAPISTS
Credential: OTRL
Phone: 501-215-6508