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General NPI Number Information
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NPI Number | 1508414152
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Entity Type | Individual
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Provider Name | MARSHA MOORE BERTASI OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 1300 BRADEN ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076-3719
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Country | US
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Telephone | 501-241-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PLANTATION ACRES DR
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City | LITTLE ROCK
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State | AR
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Zip | 72210-3626
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Country | US
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Telephone | 501-590-4259
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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 | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | OTR1607
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License Number State | AR
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