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General NPI Number Information
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NPI Number | 1790810414
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Entity Type | Individual
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Provider Name | KELLI KOTLARZ RAWN O.TR/L
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 2400 W MAIN ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076
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Country | US
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Telephone | 501-982-4578
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Fax | 501-533-6326
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Provider Business Mailing Address
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Address Line | 6720 WAVERLY DRIVE
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City | LITTLE ROCK
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State | AR
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Zip | 72207
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Country | US
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Telephone | 501-944-3420
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTR1972
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License Number State | AR
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