Healthcare Provider Details

I. General information

NPI: 1053869180
Provider Name (Legal Business Name): CRAIG HLADUN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 MCKENZIE RD SUITE C
SPRINGDALE AR
72762-0747
US

IV. Provider business mailing address

2070 MCKENZIE RD SUITE C
SPRINGDALE AR
72762-0747
US

V. Phone/Fax

Practice location:
  • Phone: 870-404-3243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2962
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: