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General NPI Number Information
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NPI Number | 1124758586
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Entity Type | Organization
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Legal Business Name | EQUINOVATE THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 9288 MARS HILL RD
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City | BAUXITE
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State | AR
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Zip | 72011-8024
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Country | US
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Telephone | 502-849-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 9288 MARS HILL RD
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City | BAUXITE
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State | AR
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Zip | 72011-8024
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Country | US
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Telephone | 501-849-8644
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | SARA HICKS
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Credential | COTA/L
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Telephone | 501-849-8644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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