Organization
ROBERT MACK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT GARY MACK II OTRL (PRESIDENT)
(479) 414-1190
Entity
Organization
Contact information
Practice address
1801 SOUTH 74, FT SMITH, AR 72902
(479) 478-5572
(479) 478-5560
Mailing address
2712 EDGEWATER DRIVE, GREENWOOD, AR 72936
(479) 414-1190
(479) 478-5560
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR940
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146815742
—
AR
Enumeration date
05/14/2008
Last updated
05/14/2008
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