Healthcare Provider Details

I. General information

NPI: 1235877903
Provider Name (Legal Business Name): KRISTA DEWEESE OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 MCKENZIE RD STE C
SPRINGDALE AR
72762-0870
US

IV. Provider business mailing address

2075 N COLLEGE AVE
FAYETTEVILLE AR
72703-2613
US

V. Phone/Fax

Practice location:
  • Phone: 479-799-7975
  • Fax:
Mailing address:
  • Phone: 479-799-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR4232
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: