Healthcare Provider Details

I. General information

NPI: 1578200770
Provider Name (Legal Business Name): VIRIDIANA HURTADO OT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS VIRIDIANA TORRES

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W POPLAR ST
ROGERS AR
72756-4242
US

IV. Provider business mailing address

113 S BAILEY ST
LOWELL AR
72745-8448
US

V. Phone/Fax

Practice location:
  • Phone: 479-631-7678
  • Fax:
Mailing address:
  • Phone: 479-770-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1840
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: