MEDICARE: CRAIG WINTERS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTR1644	AR

General Provider Information

NPI Number	:	1316001555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG WINTERS OTR

Provider Business Mailing Address
First Line	:	229 ENGLEWOOD RD
Second Line	:
City	:	CAMMACK VILLAGE
State	:	AR
Zip	:	72207-1803
Country	:	US
Telephone Number	:	501-664-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 N POPLAR ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2332
Country	:	US
Telephone Number	:	501-771-8255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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