Healthcare Provider Details

I. General information

NPI: 1396525309
Provider Name (Legal Business Name): THERAPY SERVICES PT AND OT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HOPKINS RD
WILLIAMSVILLE NY
14221-2320
US

IV. Provider business mailing address

4933 OLD GREENWOOD RD
FORT SMITH AR
72903-6906
US

V. Phone/Fax

Practice location:
  • Phone: 479-201-6091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TRACY MCCALL
Title or Position: CREDENTIALING
Credential:
Phone: 479-201-6091