Healthcare Provider Details

I. General information

NPI: 1730147976
Provider Name (Legal Business Name): HEATHER MICHELLE LITCHFORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 N PLAINVIEW AVE
FAYETTEVILLE AR
72703-4065
US

IV. Provider business mailing address

3419 N PLAINVIEW AVE
FAYETTEVILLE AR
72703-4065
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-4001
  • Fax: 479-521-1621
Mailing address:
  • Phone: 479-521-4001
  • Fax: 479-521-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-0252A
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR-1848
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: