Individual
BAILEY GRACE LATCHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
707 N CARDINAL DR STE 4, MOUNTAIN HOME, AR 72653-3274
(870) 404-0270
Mailing address
109 RYAN RD APT 3, COTTER, AR 72626-9208
(501) 859-4093
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1886
AR
Other
Enumeration date
10/13/2022
Last updated
07/14/2023
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