Individual
MRS. THERESA MARIE FUNKHOUSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
7401 MARCHE LATERAL RD, NORTH LITTLE ROCK, AR 72118-1693
(501) 851-2473
(501) 851-3862
Mailing address
7401 MARCHE LATERAL RD, NORTH LITTLE ROCK, AR 72118-1693
(501) 851-2473
(501) 851-3862
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR1279
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X125
BLUE CROSS & BLUE SHIELD
AR
Enumeration date
10/12/2006
Last updated
07/08/2007
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