Provider Demographics
NPI:1780619338
Name:TEAGUE OCCUPATIONAL THERAPY SERVICES, INC
Entity type:Organization
Organization Name:TEAGUE OCCUPATIONAL THERAPY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:DESHON
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:501-624-3606
Mailing Address - Street 1:195 LONGVIEW PT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8718
Mailing Address - Country:US
Mailing Address - Phone:501-262-9369
Mailing Address - Fax:501-318-0383
Practice Address - Street 1:1801 CENTRAL AVE STE H
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6800
Practice Address - Country:US
Practice Address - Phone:501-624-3606
Practice Address - Fax:501-318-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR848225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U336OtherBLUE CROSS BLUE SHIELD