Healthcare Provider Details

I. General information

NPI: 1164177424
Provider Name (Legal Business Name): KRISTIN LEIGH LASHLEY OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WHITE DR
BATESVILLE AR
72501-2001
US

IV. Provider business mailing address

880 CHINQUAPIN LOOP
BATESVILLE AR
72501-7990
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-8120
  • Fax:
Mailing address:
  • Phone: 870-847-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1810
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: