Healthcare Provider Details

I. General information

NPI: 1700215662
Provider Name (Legal Business Name): CRYSTAL D HENRY OTR/L,CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 COLEY DR
MOUNTAIN HOME AR
72653-2523
US

IV. Provider business mailing address

804 COLEY DR
MOUNTAIN HOME AR
72653-2523
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-2224
  • Fax: 870-424-0493
Mailing address:
  • Phone: 870-424-2224
  • Fax: 870-424-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1340
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOTR1340
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTR1340
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTR1340
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1340
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR1340
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: