Healthcare Provider Details

I. General information

NPI: 1275872749
Provider Name (Legal Business Name): VITO VILLA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

4800 HAMPTON RD
NORTH LITTLE ROCK AR
72116-6886
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 501-563-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1456
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: