1780619338 NPI number — TEAGUE OCCUPATIONAL THERAPY SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780619338 NPI number — TEAGUE OCCUPATIONAL THERAPY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAGUE OCCUPATIONAL THERAPY SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780619338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 CENTRAL AVE STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-624-3606
Provider Business Practice Location Address Fax Number:
501-318-0383
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
SONJA
Authorized Official Middle Name:
DESHON
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
501-624-3606

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OTR848 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5U336 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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