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NPI Code Detail

MEDICARE: MRS. MARY KATRINA GROSS MOTR/L

MEDICARE: MRS. MARY KATRINA GROSS MOTR/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
1225X00000XOccupational TherapistOTR2344AR

General Provider Information

NPI Number : 1881918076
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY KATRINA GROSS MOTR/L
Provider Business Mailing Address
First Line : 214 HOPE LANDING RD
Second Line :
City : EL DORADO
State : AR
Zip : 71730-8725
Country : US
Telephone Number : 870-862-0500
Fax Number : 870-862-2100
Provider Business Practice Location Address
First Line : 214 HOPE LANDING RD
Second Line :
City : EL DORADO
State : AR
Zip : 71730-8725
Country : US
Telephone Number : 870-862-0500
Fax Number : 870-862-2100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2010
Last Update Date : 03/17/2010

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