Healthcare Provider Details

I. General information

NPI: 1659066348
Provider Name (Legal Business Name): HANNAH ELIZA-GRACE FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TERRY POND CV
WHITE HALL AR
71602-8212
US

IV. Provider business mailing address

315 TERRY POND CV
WHITE HALL AR
71602-8212
US

V. Phone/Fax

Practice location:
  • Phone: 501-827-6796
  • Fax:
Mailing address:
  • Phone: 501-827-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3790
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: