Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 1979 | AR |
NPI | 1043423411 |
---|---|
Provider Name | Mrs. Callie Antuna |
First Address | Bella Vista, AR 72714 |
Second Address | Bentonville, AR 72712-2011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 09/07/2007 |