MEDICARE: MRS. KRISTI MICHELLE LOWERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTR969	AR

General Provider Information

NPI Number	:	1477647394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTI MICHELLE LOWERY

Provider Business Mailing Address
First Line	:	3691 CHAPEL DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-8003
Country	:	US
Telephone Number	:	870-863-3011
Fax Number	:	870-862-2100

Provider Business Practice Location Address
First Line	:	214 HOPE LANDING
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-0000
Country	:	US
Telephone Number	:	870-862-0500
Fax Number	:	870-862-2100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/01/2008

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