Healthcare Provider Details

I. General information

NPI: 1609209147
Provider Name (Legal Business Name): PAUL W CREEL OTR/L CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 547-11
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST # 547-11
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-6102
  • Fax: 501-296-1216
Mailing address:
  • Phone: 501-686-6102
  • Fax: 501-296-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR 371
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: