Healthcare Provider Details

I. General information

NPI: 1396841490
Provider Name (Legal Business Name): DARLENE S BOUDREAUX OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARLENE S ST JOHN OTR

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W DEWITT HENRY DR
BEEBE AR
72012-2026
US

IV. Provider business mailing address

897 SHILOH RD
BEEBE AR
72012-9897
US

V. Phone/Fax

Practice location:
  • Phone: 501-288-1199
  • Fax: 501-882-3179
Mailing address:
  • Phone: 501-288-1199
  • Fax: 501-882-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR751
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: