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Individual

MS. KERA BETH ADDISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, OTR/L

Contact information

Practice address
1625 S MAIN ST, MALVERN, AR 72104-5600
(501) 332-1818
Mailing address
1625 S MAIN ST, MALVERN, AR 72104-5600
(501) 332-1818

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR2220
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
175282721
AR
Enumeration date
11/14/2008
Last updated
06/24/2009
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