Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1004448 | AR |
NPI | 1003969528 |
---|---|
Provider Name | Mrs. Kristi Matthews |
First Address | Benton, AR 72015-9563 |
Second Address | Benton, AR 72015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |