Healthcare Provider Details

I. General information

NPI: 1235857731
Provider Name (Legal Business Name): FAITH CARTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MISSOURI ST
WEST MEMPHIS AR
72301-3148
US

IV. Provider business mailing address

610 N MISSOURI ST
WEST MEMPHIS AR
72301-3148
US

V. Phone/Fax

Practice location:
  • Phone: 870-400-0179
  • Fax:
Mailing address:
  • Phone: 870-400-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR3664
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: