NPIMap

Organization Active NPI

Imagine Occupational Therapy Services

Doing business as Imagine Pediatric Therapies

  • Occupational Therapist
  • Bentonville, AR
National Provider Identifier
1124241120
Registry record updated Mar 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
IMAGINE OCCUPATIONAL THERAPY SERVICES
Doing business as
Imagine Pediatric Therapies
Practice address
1601 Greenhouse Rd.
Bentonville, AR 72712-9292
Phone
(479) 795-1260
Fax
(479) 795-1261
NPI assigned
Apr 10, 2007
Last updated
Mar 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tabitha Dawn Richison, OTR
Title
President
Phone
(479) 795-1260

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

1601 Greenhouse Rd.
Bentonville, AR 72712-9292

Mailing address

1601 Greenhouse Rd.
Bentonville, AR 72712-9292
Phone (479) 795-1260

Other identifiers 2

IdentifierTypeStateIssuer
5F709OtherARBCBS
162908742MedicaidAR

Other names 1

  • Imagine Pediatric Therapies Doing business as

National Provider Directory

National Provider Directory

Locations

1601 Greenhouse Rd
Bentonville, AR 72713
Phone (479) 795-1260

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458777600000",
    "number": "1124241120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 GREENHOUSE RD.",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727129292",
            "telephone_number": "479-795-1260",
            "fax_number": "479-795-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GREENHOUSE RD.",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727129292",
            "telephone_number": "479-795-1260",
            "fax_number": "479-795-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE OCCUPATIONAL THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2016-03-24",
        "status": "A",
        "authorized_official_last_name": "RICHISON",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-795-1260",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5F709",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162908742",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imagine Pediatric Therapies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.