Healthcare Provider Details

I. General information

NPI: 1306506522
Provider Name (Legal Business Name): MOLLY ELIZABETH CHILTON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LAKE PARK LOOP
MOUNTAIN HOME AR
72653-6770
US

IV. Provider business mailing address

299 LAKE PARK LOOP
MOUNTAIN HOME AR
72653-6770
US

V. Phone/Fax

Practice location:
  • Phone: 870-321-3384
  • Fax: 870-361-8698
Mailing address:
  • Phone: 417-522-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3613
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: