=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144501966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTY A ENGLAND OTL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2011
-----------------------------------------------------
Last Update Date | 09/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 W WATSON ST # 1
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72701-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-612-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 986 ELMWOOD STREET STE B
-----------------------------------------------------
City | SPRINGDALE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-750-7778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | O-T1150
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------