Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OT-A1677 | AR |
NPI | 1023600657 |
---|---|
Provider Name | Mrs. Brittney Havens |
First Address | El Dorado, AR 71730-9231 |
Second Address | El Dorado, AR 71730-3775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2021 |
Last Update Date | 04/02/2021 |