Individual
MRS. ALICIA M BOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.O.T.R.L.
Contact information
Practice address
2315 HONEYSUCKLE LN, RUSSELLVILLE, AR 72801-5526
(479) 858-6144
(479) 858-6144
Mailing address
107 S CRESTLINER ST, MORRILTON, AR 72110-3707
(501) 977-0649
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR1799
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y829
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/19/2007
Last updated
07/08/2007
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