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General NPI Number Information
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NPI Number | 1003107434
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Entity Type | Organization
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Legal Business Name | ARKANSAS THERAPY OUTREACH, LLC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 3851 LEGACY VILLAGE DR
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City | BENTON
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State | AR
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Zip | 72015-9745
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Country | US
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Telephone | 501-350-7572
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Fax | 501-776-4059
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Provider Business Mailing Address
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Address Line | 3851 LEGACY VILLAGE DR
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City | BENTON
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State | AR
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Zip | 72015-9745
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Country | US
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Telephone | 501-350-7572
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Fax | 501-776-4059
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST/OWNER
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Name | MRS. REBEKAH MARIE JAMES
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Credential | M.S., CCC-SLP
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Telephone | 501-350-7572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP#2655
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License Number State | AR
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