Individual
PAM PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 COTTONWOOD LN, GREEN FOREST, AR 72638-2360
(870) 350-1173
Mailing address
PO BOX 761, BERRYVILLE, AR 72616-0761
(870) 350-1173
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT2996
PHYSICAL THERAPIST
—
Enumeration date
02/24/2010
Last updated
02/24/2010
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