=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174079453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAACS OCCUPATIONAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2016
-----------------------------------------------------
Last Update Date | 08/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 COURT RD
-----------------------------------------------------
City | ASH FLAT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-710-0377
-----------------------------------------------------
Fax | 870-994-2372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 115
-----------------------------------------------------
City | ASH FLAT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72513-0115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-710-0377
-----------------------------------------------------
Fax | 870-994-2372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MRS. MELANIE ANN ISAACS
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 870-710-0377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OTR524
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------