=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821233438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NWA ORTHOSPINE REHAB SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2008
-----------------------------------------------------
Last Update Date | 12/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2783 N SHILOH DR SUITE 102
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-6983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-444-6768
-----------------------------------------------------
Fax | 479-444-6264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 841
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72602-0841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-444-6768
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | NORMA LEE SEBAG-STOCKSTILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-444-6768
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------