Individual
AMANDA ELLISHA KEASTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
920 UNIVERSITY DR, RUSSELLVILLE, AR 72801-4303
(479) 967-2322
(479) 967-2876
Mailing address
P.O. DRAWER 2109, RUSSELLVILLE, AR 72811-2109
(479) 967-2322
(479) 967-2876
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2066
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162765721
—
AR
01
—
5A030
BLUE CROSS BLUE SHIELD
AR
01
—
662725
HEALTHLINK
AR
Enumeration date
08/25/2006
Last updated
07/21/2023
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