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General NPI Number Information
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NPI Number | 1831250968
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Entity Type | Organization
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Legal Business Name | LILES THERAPY INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1417 ROLLING RIDGE CIR
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City | TEXARKANA
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State | AR
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Zip | 71854-9036
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Country | US
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Telephone | 903-276-6012
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Fax | 870-773-9869
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Provider Business Mailing Address
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Address Line | 1417 ROLLING RIDGE CIR
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City | TEXARKANA
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State | AR
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Zip | 71854-9036
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Country | US
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Telephone | 903-276-6012
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Fax | 870-773-9869
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN PAUL LILES
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Credential | OTR
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Telephone | 903-276-6012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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