MEDICARE: JANET TOWNSLEY OTRL

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	174400000X	Specialist	OTR439	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5S361	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1356485866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET TOWNSLEY OTRL

Provider Business Mailing Address
First Line	:	1152 OCEAN BLVD
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-8320
Country	:	US
Telephone Number	:	870-269-3567
Fax Number	:

Provider Business Practice Location Address
First Line	:	1152 OCEAN BLVD
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-8320
Country	:	US
Telephone Number	:	870-269-7529
Fax Number	:	870-269-2840

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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