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General NPI Number Information
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NPI Number | 1457090466
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Entity Type | Organization
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Legal Business Name | SOUTH WEST PEDIATRIC THERAPY
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 600 MAIN ST STE L
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City | HOT SPRINGS
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State | AR
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Zip | 71913-4964
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Country | US
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Telephone | 501-232-7552
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Fax |
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Provider Business Mailing Address
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Address Line | 155 SAN FELIPE RD
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City | HOT SPRINGS
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State | AR
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Zip | 71909-9726
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Country | US
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Telephone | 501-844-0453
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELODY ANN HALL
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Credential | COTA/L
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Telephone | 501-844-0453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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