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General NPI Number Information
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NPI Number | 1427727569
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Entity Type | Organization
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Legal Business Name | EMPOWERED THERAPY COLLECTIVE LLC
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1845 MAIN DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5220
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Country | US
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Telephone | 479-315-0715
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Fax | 479-308-0285
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Provider Business Mailing Address
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Address Line | 1275 S JASMINE LN
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-7708
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Country | US
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Telephone | 479-315-0715
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Fax | 479-308-0285
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST, OWNER
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Name | TARYN TAYLOR
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Credential | M.S. CCC-SLP
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Telephone | 479-315-0715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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