Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OT-A1226 | AR |
NPI | 1023665023 |
---|---|
Provider Name | James Earl Burtrom |
First Address | Batesville, AR 72501-7837 |
Second Address | Mountain View, AR 72560-8601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 23/08/2019 |