Individual
TAYLOR N LICHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1915 W MAIN ST, RUSSELLVILLE, AR 72801-2725
(479) 968-1198
Mailing address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-1198
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR3071
AR
Other
Enumeration date
10/03/2017
Last updated
10/03/2017
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