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General NPI Number Information
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NPI Number | 1023715208
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Entity Type | Organization
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Legal Business Name | HEAVENLY THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 8103 BEAR HOLLOW RD
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City | FORT SMITH
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State | AR
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Zip | 72916-7416
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Country | US
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Telephone | 479-650-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 8103 BEAR HOLLOW RD
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City | FORT SMITH
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State | AR
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Zip | 72916-7416
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Country | US
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Telephone | 479-650-2466
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | ANGELA FISHER
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Credential | OTR/L
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Telephone | 479-650-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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