Provider Demographics
NPI:1639859267
Name:DELTA RESILIENCE LLC
Entity type:Organization
Organization Name:DELTA RESILIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:870-584-8064
Mailing Address - Street 1:911 PORT ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-3138
Mailing Address - Country:US
Mailing Address - Phone:870-584-8064
Mailing Address - Fax:
Practice Address - Street 1:1127 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4033
Practice Address - Country:US
Practice Address - Phone:870-584-8064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty