Healthcare Provider Details

I. General information

NPI: 1639136807
Provider Name (Legal Business Name): THERATEAM REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 ROLAND HEIGHTS RD
ROLAND AR
72135-9685
US

IV. Provider business mailing address

20900 ROLAND HEIGHTS RD
ROLAND AR
72135-9685
US

V. Phone/Fax

Practice location:
  • Phone: 501-868-4760
  • Fax: 501-868-6498
Mailing address:
  • Phone: 501-868-4760
  • Fax: 501-868-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP #1076
License Number StateAR

VIII. Authorized Official

Name: MRS. REEDA RUTH WILLIAMSON
Title or Position: PRESIDENT/SPEECH LANGUAGE PATHOLOGI
Credential: M.S.E., CCC-SLP
Phone: 501-868-4760