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General NPI Number Information
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NPI Number | 1336573583
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Entity Type | Organization
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Legal Business Name | ARKANSAS THERAPY OUTREACH CONTRACTOR
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 2615 N PRICKETT RD STE 3
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City | BRYANT
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State | AR
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Zip | 72022-7546
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Country | US
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Telephone | 501-847-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 N PRICKETT RD STE 3
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City | BRYANT
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State | AR
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Zip | 72022-7546
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | CHARLA MOORE
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Credential |
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Telephone | 501-358-9894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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