MEDICARE: TEAGUE OCCUPATIONAL THERAPY SERVICES, INC

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	225XP0200X	Pediatric Occupational Therapist	OTR848	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5U336	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780619338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAGUE OCCUPATIONAL THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	195 LONGVIEW PT
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-8718
Country	:	US
Telephone Number	:	501-262-9369
Fax Number	:	501-318-0383

Provider Business Practice Location Address
First Line	:	1801 CENTRAL AVE STE H
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-6800
Country	:	US
Telephone Number	:	501-624-3606
Fax Number	:	501-318-0383

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. SONJA DESHON TEAGUE
Credential	:	OTR
Telephone Number	:	501-624-3606

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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