Healthcare Provider Details

I. General information

NPI: 1841323029
Provider Name (Legal Business Name): BLAKELEY NOLTE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 N RODNEY PARHAM RD
LITTLE ROCK AR
72227-6212
US

IV. Provider business mailing address

6616 WAVERLY PL
LITTLE ROCK AR
72207-3528
US

V. Phone/Fax

Practice location:
  • Phone: 501-228-3908
  • Fax:
Mailing address:
  • Phone: 501-664-5868
  • Fax: 501-228-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1863
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: