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General NPI Number Information
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NPI Number | 1033673538
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Entity Type | Individual
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Provider Name | ETHAN PARKER BACHMAN MS OTR/L
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Gender | Male
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 2801 OLD GREENWOOD RD STE 14
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City | FORT SMITH
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State | AR
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Zip | 72903-4560
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Country | US
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Telephone | 479-434-2371
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 BEACH ACRES DR
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City | VAN BUREN
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State | AR
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Zip | 72956-7710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR3266
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License Number State | AR
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