Individual
KENNETH OMALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
501 N MAIN ST, STE C, HARRISON, AR 72601-3535
(870) 743-5573
(870) 743-5974
Mailing address
PO BOX 841, HARRISON, AR 72602-0841
(870) 743-5573
(870) 743-5974
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2117
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTR2117
OTR LICENSE
AR
Enumeration date
04/09/2013
Last updated
04/09/2013
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