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General NPI Number Information
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NPI Number | 1740795541
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Entity Type | Organization
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Legal Business Name | PRISM EDUCATION CENTER
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 2855 E JOYCE BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4524
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Country | US
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Telephone | 479-249-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 E JOYCE BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4524
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Country | US
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Telephone | 479-249-6113
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISTY NEWCOMB
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Credential |
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Telephone | 479-249-6113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical 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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR1879
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License Number State | AR
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Taxonomy #3
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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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