Individual
ALICIA LADAWN WIDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 RUSSELL RD, RUSSELLVILLE, AR 72802-4320
(479) 967-2316
(479) 967-3639
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
(479) 967-2876
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2018-032
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233326721
—
AR
Enumeration date
10/18/2018
Last updated
01/12/2023
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