Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTR3068 | AR |
NPI | 1003575564 |
---|---|
Provider Name | Sarah Davis |
First Address | Conway, AR 72034-9640 |
Second Address | Harrison, AR 72601-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 13/12/2021 |