Individual
KARRIE TALLAKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2620 SHADOW LAKE DR, GREENWOOD, AR 72936-6202
(479) 996-5706
Mailing address
2620 SHADOW LAKE DR, GREENWOOD, AR 72936-6202
(479) 996-5706
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
486
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100651690A
—
OK
05
—
130721721
—
AR
01
—
5T589
BCBS
AR
Enumeration date
04/02/2006
Last updated
09/23/2008
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