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: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N REYNOLDS RD
BRYANT AR
72022-3034
US

IV. Provider business mailing address

PO BOX 2109
RUSSELLVILLE AR
72811-2109
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-2322
  • Fax: 479-763-3308
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-763-3308

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: