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General NPI Number Information
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NPI Number | 1366832438
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Entity Type | Organization
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Legal Business Name | THERA-PLAY PEDIATRIC THERAPY ASSOCIATES
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 3114 FOX ROAD
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City | JONESBORO
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State | AR
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Zip | 72404-9322
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Country | US
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Telephone | 870-926-7725
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 16011
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City | JONESBORO
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State | AR
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Zip | 72403-6700
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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 | THERAPY SUPERVISOR
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Name | BRANDI STEELE
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Credential | OTD, OTR/L
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Telephone | 870-926-7725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | AR
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