Healthcare Provider Details

I. General information

NPI: 1437794864
Provider Name (Legal Business Name): HEATHER DAWN KEIRN OTD, R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 HARRISON ST
BATESVILLE AR
72501-7424
US

IV. Provider business mailing address

28 RIVER RIDGE LN
ROSIE AR
72571-9664
US

V. Phone/Fax

Practice location:
  • Phone: 870-805-5793
  • Fax: 870-569-8063
Mailing address:
  • Phone: 870-612-0419
  • Fax: 870-569-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3340
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: