Healthcare Provider Details

I. General information

NPI: 1699977173
Provider Name (Legal Business Name): KATHRYN DUCKETT IRBY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN DUCKETT WHITE OTR

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MUSEUM RD SUITE 104
CONWAY AR
72032-4710
US

IV. Provider business mailing address

1500 MUSEUM RD SUITE 104
CONWAY AR
72032-4710
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3804
  • Fax: 501-329-0718
Mailing address:
  • Phone: 501-329-3804
  • Fax: 501-329-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number370
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: