Healthcare Provider Details

I. General information

NPI: 1952524910
Provider Name (Legal Business Name): DIANE ALICIA HANLEY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7413 HENDERSON RD
LITTLE ROCK AR
72210-4201
US

IV. Provider business mailing address

7413 HENDERSON RD
LITTLE ROCK AR
72210-4201
US

V. Phone/Fax

Practice location:
  • Phone: 501-455-1412
  • Fax:
Mailing address:
  • Phone: 501-455-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR145
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: