Healthcare Provider Details

I. General information

NPI: 1508414152
Provider Name (Legal Business Name): MARSHA MOORE BERTASI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BRADEN ST
JACKSONVILLE AR
72076-3719
US

IV. Provider business mailing address

19 PLANTATION ACRES DR
LITTLE ROCK AR
72210-3626
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-1000
  • Fax:
Mailing address:
  • Phone: 501-590-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR1607
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: