Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTR1340 | AR |
N | 225XE0001X | Environmental Modification | OTR1340 | AR |
N | 225XH1200X | Occupational Therapist - Hand | OTR1340 | AR |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTR1340 | AR |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTR1340 | AR |
N | 225XP0200X | Occupational Therapist - Pediatrics | OTR1340 | AR |
NPI | 1700215662 |
---|---|
Provider Name | Crystal D Henry |
First Address | Oakland, AR 72661-9183 |
Second Address | Mountain Home, AR 72653-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2013 |
Last Update Date | 03/07/2014 |