Individual
REBECCA DECLERK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1307 SE 22ND ST, BENTONVILLE, AR 72712-6853
(870) 378-4558
Mailing address
22516 E CREOSOTE DR, QUEEN CREEK, AZ 85142-8530
(870) 378-4558
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1235
AR
225X00000X
Occupational Therapist
6765
AZ
Other
Enumeration date
01/25/2017
Last updated
05/24/2021
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