Individual
ZOE DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6836 ISAACS ORCHARD RD, SPRINGDALE, AR 72762-6096
(479) 927-4100
(479) 927-1373
Mailing address
6836 ISAACS ORCHARD RD, SPRINGDALE, AR 72762-6096
(479) 927-4100
(479) 927-1373
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303859706
—
AR
Enumeration date
07/21/2023
Last updated
07/21/2023
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