Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTR1443 | AR |
NPI | 1003950304 |
---|---|
Provider Name | Mrs. Misty Milam Kennedy |
First Address | Marion, AR 72364-3046 |
Second Address | Marion, AR 72364-1755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |