Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTR1799 | AR |
NPI | 1053538587 |
---|---|
Provider Name | Mrs. Alicia M Bost |
First Address | Morrilton, AR 72110-3707 |
Second Address | Russellville, AR 72801-5526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5Y829 | BLUE CROSS BLUE SHIELD (01) | AR |