Individual
GARRETT POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 WILSON LOOP, WARD, AR 72176-8656
(501) 941-5630
Mailing address
1500 WILSON LOOP, WARD, AR 72176-8656
(501) 941-5630
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2647
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199468721
—
AR
Enumeration date
11/11/2013
Last updated
11/11/2013
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