Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OTR2841 | AR |
NPI | 1063882736 |
---|---|
Provider Name | Mrs. Katie Elizabeth Beall |
First Address | Jonesboro, AR 72404-0778 |
Second Address | Jonesboro, AR 72401-5828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 06/10/2015 |