MEDICARE: TAYLOR A COUNCE

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	171M00000X	Case Manager/Care Coordinator
2	224Z00000X	Occupational Therapy Assistant	OTA1503	AR

General Provider Information

NPI Number	:	1538575238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR A COUNCE

Provider Business Mailing Address
First Line	:	1218 STONE ST STE 140
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4568
Country	:	US
Telephone Number	:	870-336-0220
Fax Number	:	870-558-5637

Provider Business Practice Location Address
First Line	:	1218 STONE ST STE 140
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4568
Country	:	US
Telephone Number	:	870-336-0220
Fax Number	:	870-558-5637

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

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	05/15/2024

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Directions to “ TAYLOR A COUNCE ” Practice Location

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