MEDICARE: MRS. KERI JANE URQUHART OTR/L

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	OTR1165	AR

General Provider Information

NPI Number	:	1780635367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERI JANE URQUHART OTR/L

Provider Business Mailing Address
First Line	:	2814 GRAY FOX LN
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-2629
Country	:	US
Telephone Number	:	501-241-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4348
Country	:	US
Telephone Number	:	501-786-0917
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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