Individual
REBECCA J HAVNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1301 RUSSELL RD, RUSSELLVILLE, AR 72802-4320
(479) 967-2322
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A582
AR
224Z00000X
Occupational Therapy Assistant
OTA0000001644
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457688715
—
AR
Enumeration date
11/06/2009
Last updated
01/09/2023
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