Healthcare Provider Details

I. General information

NPI: 1801713524
Provider Name (Legal Business Name): MARIAH KEATHLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 MATHIAS DR
SPRINGDALE AR
72762-0985
US

IV. Provider business mailing address

4520 W TOPEKA AVE
FAYETTEVILLE AR
72704-4046
US

V. Phone/Fax

Practice location:
  • Phone: 479-419-9911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR4193
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: