Provider Demographics
NPI:1124758586
Name:EQUINOVATE THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:EQUINOVATE THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:501-849-8644
Mailing Address - Street 1:9288 MARS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BAUXITE
Mailing Address - State:AR
Mailing Address - Zip Code:72011-8024
Mailing Address - Country:US
Mailing Address - Phone:501-849-8644
Mailing Address - Fax:
Practice Address - Street 1:9288 MARS HILL RD
Practice Address - Street 2:
Practice Address - City:BAUXITE
Practice Address - State:AR
Practice Address - Zip Code:72011-8024
Practice Address - Country:US
Practice Address - Phone:502-849-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1609217918Medicaid