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General NPI Number Information
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NPI Number | 1841869427
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Entity Type | Individual
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Provider Name | KALLIE W. MANN OTR
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Gender | Female
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 650 S DODSON RD
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City | ROGERS
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State | AR
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Zip | 72758-7015
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Country | US
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Telephone | 479-271-7120
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BASILDON CIR
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City | BELLA VISTA
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State | AR
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Zip | 72715-8842
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Country | US
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Telephone | 704-472-3826
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | OTR2990
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License Number State | AR
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