Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OT-A768 | AR |
NPI | 1013201607 |
---|---|
Provider Name | Kayla Daniels |
First Address | Benton, AR 72018-1589 |
Second Address | Benton, AR 72019-2930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 17/03/2018 |