Individual
MRS. KIMBERLY BASS MCCORKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2002 LOSTWOOD, TEXARKANA, AR 71854-8194
(870) 403-1318
Mailing address
2002 LOSTWOOD LANE, TEXARKANA, AR 71854-2924
(870) 403-1318
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR 2367
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184312721
—
AR
Enumeration date
02/01/2011
Last updated
02/13/2013
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