Organization
EAGLE FAMILY THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONZO DIXON (CEO)
(870) 501-2042
Entity
Organization
Contact information
Practice address
107 PARK ST, MC GEHEE, AR 71654-2915
(870) 501-2042
Mailing address
107 PARK ST, MC GEHEE, AR 71654-2915
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
224Z00000X
Occupational Therapy Assistant
—
—
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285036913
—
AR
Enumeration date
09/25/2014
Last updated
07/08/2016
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