Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTR219 | AR |
NPI | 1003223785 |
---|---|
Provider Name | Vera Mcculloch |
First Address | Little Rock, AR 72205-1501 |
Second Address | Little Rock, AR 72205-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2014 |
Last Update Date | 15/07/2014 |