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General NPI Number Information
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NPI Number | 1811337900
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Entity Type | Organization
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Legal Business Name | SUCCESS THERAPY SERVICES
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 214 LANDON LN
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City | HARRISON
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State | AR
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Zip | 72601-1814
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Country | US
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Telephone | 870-577-2127
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Fax |
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Provider Business Mailing Address
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Address Line | 214 LANDON LN
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City | HARRISON
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State | AR
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Zip | 72601-1814
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Country | US
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Telephone | 870-577-2127
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | TRACEY RODERY I
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Credential | OTR/L
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Telephone | 870-577-2127
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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 | OTR2149
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License Number State | AR
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