MEDICARE: RAMONA THACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP#3100	AR

General Provider Information

NPI Number	:	1427421403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMONA THACH

Provider Business Mailing Address
First Line	:	1 PARK DR
Second Line	:	STE A
City	:	HOLIDAY ISLAND
State	:	AR
Zip	:	72631-9405
Country	:	US
Telephone Number	:	479-363-6422
Fax Number	:	479-363-6763

Provider Business Practice Location Address
First Line	:	1 PARK DR
Second Line	:	SUITE A
City	:	HOLIDAY ISLAND
State	:	AR
Zip	:	72631-9216
Country	:	US
Telephone Number	:	479-363-6422
Fax Number	:	479-363-6763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	03/07/2016

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Directions to “ RAMONA THACH ” Practice Location

Language	Start Address	Practice Location

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