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
—
—
225X00000X
Occupational Therapist
Primary
—
—
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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