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NPI Code Detail

MEDICARE: KALLIE W. MANN OTR

MEDICARE: KALLIE W. MANN OTR
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
1225XG0600XGerontology Occupational TherapistOTR2990AR

General Provider Information

NPI Number : 1841869427
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALLIE W. MANN OTR
Provider Business Mailing Address
First Line : 21 BASILDON CIR
Second Line :
City : BELLA VISTA
State : AR
Zip : 72715-8842
Country : US
Telephone Number : 704-472-3826
Fax Number :
Provider Business Practice Location Address
First Line : 650 S DODSON RD
Second Line :
City : ROGERS
State : AR
Zip : 72758-7015
Country : US
Telephone Number : 479-271-7120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2021
Last Update Date : 06/18/2021

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Directions to “ KALLIE W. MANN OTR” Practice Location

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