Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTR1490 | AR |
NPI | 1407050511 |
---|---|
Provider Name | Flordeliza Ople Bautista |
First Address | Bentonville, AR 72712-5004 |
Second Address | Bentonville, AR 72712-5004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 08/07/2007 |