Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OTR1527 | AR |
NPI | 1063526259 |
---|---|
Provider Name | Jerry Criley |
First Address | North Little Rock, AR 72118-2012 |
Second Address | Little Rock, AR 72205-5446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |