Healthcare Provider Details

I. General information

NPI: 1467411249
Provider Name (Legal Business Name): KELLY MURDOCH HAY OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17706 I-30 STE 3
BENTON AR
72015
US

IV. Provider business mailing address

17706 I-30 STE 3
BENTON AR
72015
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4414
  • Fax: 501-315-3467
Mailing address:
  • Phone: 501-315-4414
  • Fax: 501-315-3467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1629
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: