Individual
MR. MARK ROBERT MAULIT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
810 JOE BROOKS DR, JONESBORO, AR 72401-4133
(870) 931-6789
(870) 931-4363
Mailing address
PO BOX 540, JONESBORO, AR 72403-0540
(870) 931-6789
(870) 931-4363
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR1898
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y005
BCBS INDIV PROVIDER #
AR
Enumeration date
04/14/2006
Last updated
07/08/2007
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