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General NPI Number Information
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NPI Number | 1235561838
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Entity Type | Organization
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Legal Business Name | QUALLS THERAPY SERVICES INC
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 169 RAINBOW LN
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City | CAVE CITY
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State | AR
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Zip | 72521-9815
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Country | US
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Telephone | 870-307-4736
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Fax | 870-283-6304
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Provider Business Mailing Address
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Address Line | 169 RAINBOW LN
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City | CAVE CITY
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State | AR
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Zip | 72521-9815
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Country | US
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Telephone | 870-307-4736
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Fax | 870-283-6304
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Authorized Official
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Title or Position | OWNER
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Name | KAYLA MARIE QUALLS
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Credential | MS, OTR/L
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Telephone | 870-307-4736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OTR2256
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License Number State | AR
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