Healthcare Provider Details

I. General information

NPI: 1740394113
Provider Name (Legal Business Name): ROBERT WILLIAM HILL CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DRIVE 118/NLR
NORTH LITTLE ROCK AR
72114
US

IV. Provider business mailing address

3490 E KIEHL AVE APARTMENT 9007
SHERWOOD AR
72120-3316
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3274
  • Fax:
Mailing address:
  • Phone: 501-804-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number42184
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: