MEDICARE: WILLIAM T WITHAM LPN

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	171M00000X	Case Manager/Care Coordinator	L43821	AR

General Provider Information

NPI Number	:	1619122181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM T WITHAM LPN

Provider Business Mailing Address
First Line	:	1014 AUTUMN RD
Second Line	:	STE. 3
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3704
Country	:	US
Telephone Number	:	501-221-1941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 AUTUMN RD
Second Line	:	STE. 3
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3704
Country	:	US
Telephone Number	:	501-221-1941
Fax Number	:

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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Directions to “ WILLIAM T WITHAM LPN” Practice Location

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