Healthcare Provider Details

I. General information

NPI: 1003969528
Provider Name (Legal Business Name): KRISTI MATTHEWS O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 WINCHESTER DR.
BENTON AR
72015
US

IV. Provider business mailing address

1347 VANDERBUILT DR
BENTON AR
72015-9563
US

V. Phone/Fax

Practice location:
  • Phone: 501-326-6160
  • Fax:
Mailing address:
  • Phone: 501-794-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1004448
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: