Healthcare Provider Details

I. General information

NPI: 1932818291
Provider Name (Legal Business Name): AUBURN TELANO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 MCKENZIE ST UNIT C
SPRINGDALE AR
72762
US

IV. Provider business mailing address

2169 ORIOLE ST APT A
SPRINGDALE AR
72764-5043
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-7778
  • Fax:
Mailing address:
  • Phone: 318-307-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3735
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: