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General NPI Number Information
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NPI Number | 1467561688
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Entity Type | Organization
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Legal Business Name | JARVIS PEDIATRIC THERAPY, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3896 ELM SPRINGS RD SUITE D
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City | SPRINGDALE
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State | AR
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Zip | 72762-2703
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Country | US
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Telephone | 479-750-7778
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Fax | 479-750-7708
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Provider Business Mailing Address
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Address Line | 3896 ELM SPRINGS RD SUITE D
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City | SPRINGDALE
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State | AR
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Zip | 72762-2703
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Country | US
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Telephone | 479-750-7778
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Fax | 479-750-7708
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Authorized Official
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Title or Position | OWNER/OPERATER
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Name | MRS. WENDY LEE JARVIS
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Credential | OTR/L
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Telephone | 479-750-7778
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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 | OTR639
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License Number State | AR
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