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Organization
IMAGINE OCCUPATIONAL THERAPY SERVICES
Active
Organization
IMAGINE OCCUPATIONAL THERAPY SERVICES
Active
Other names
Imagine Pediatric Therapies
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TABITHA DAWN RICHISON OTR (PRESIDENT)
(479) 795-1260
Entity
Organization
Contact information
Practice address
1601 GREENHOUSE RD., BENTONVILLE, AR 72712-9292
(479) 795-1260
(479) 795-1261
Mailing address
1601 GREENHOUSE RD., BENTONVILLE, AR 72712-9292
(479) 795-1260
(479) 795-1261
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
NULL
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162908742
—
AR
01
—
5F709
BCBS
AR
Enumeration date
04/10/2007
Last updated
03/24/2016
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