Healthcare Provider Details

I. General information

NPI: 1366576209
Provider Name (Legal Business Name): JACQUELINE LAFLEUR BELL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N TYLER ST
LITTLE ROCK AR
72205-3535
US

IV. Provider business mailing address

1004 N POLK ST
LITTLE ROCK AR
72205-1733
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-2961
  • Fax: 501-664-6208
Mailing address:
  • Phone: 501-614-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR 414
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: