MEDICARE: MS. KAREN ANN ROSS OTA/L

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	224Z00000X	Occupational Therapy Assistant	O-T0976	AR

General Provider Information

NPI Number	:	1588994941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN ANN ROSS OTA/L

Provider Business Mailing Address
First Line	:	1212 NORSWORTHY ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-7757
Country	:	US
Telephone Number	:	870-881-8942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 NORSWORTHY ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-7757
Country	:	US
Telephone Number	:	870-881-8942
Fax Number	:

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

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	01/07/2010

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