=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922130368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERINTENDENT OF DELIGHT HIGH SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 10/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 E. CHERRY ST.
-----------------------------------------------------
City | DELIGHT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-379-2214
-----------------------------------------------------
Fax | 870-379-2448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8
-----------------------------------------------------
City | DELIGHT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71940-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-379-2214
-----------------------------------------------------
Fax | 870-379-2448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | LAVON FLAHERTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-379-2214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------