Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTR2465 | AR |
NPI | 1023392065 |
---|---|
Provider Name | Kelly O'toole |
First Address | Fayetteville, AR 72703-4932 |
Second Address | Fayetteville, AR 72703-4932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2011 |
Last Update Date | 10/10/2011 |