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General NPI Number Information
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NPI Number | 1104624030
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Entity Type | Individual
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Provider Name | SKYLAR LEE BURNS
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Gender | Male
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 305 W 1ST AVE STE B
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City | CROSSETT
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State | AR
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Zip | 71635-2896
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Country | US
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Telephone | 870-304-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 118 BOB O LINK CIR
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City | HOT SPRINGS
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State | AR
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Zip | 71913-5849
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Country | US
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Telephone | 870-904-3090
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OT-A1041
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License Number State | AR
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