Healthcare Provider Details

I. General information

NPI: 1124836580
Provider Name (Legal Business Name): CAROLINE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 SCHOOL AVE
WEST FORK AR
72774-3124
US

IV. Provider business mailing address

PO BOX 2109
RUSSELLVILLE AR
72811-2109
US

V. Phone/Fax

Practice location:
  • Phone: 479-839-3349
  • Fax: 479-839-3752
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-339-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: