| NPI | 1043906142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VONDA KAY RAY Member 870-476-2983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0700X Clinic/Center, Hearing and Speech |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 252Y00000X Early Intervention Provider Agency | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-27 |