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General NPI Number Information
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NPI Number | 1922216605
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Entity Type | Organization
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Legal Business Name | SIGNATURE THERAPY
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3410 JACK CULLEN
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City | TEXARKANA
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State | AR
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Zip | 71854
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Country | US
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Telephone | 870-774-0382
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 JACK CULLEN
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City | TEXARKANA
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State | AR
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Zip | 71854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY MCLEAN
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Credential |
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Telephone | 870-774-0382
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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 | OT1335
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License Number State | AR
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