Individual
ALLIE RAY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
416 PULLMAN RD, DE QUEEN, AR 71832-9221
(870) 784-3353
Mailing address
416 PULLMAN RD, DE QUEEN, AR 71832-9221
(870) 784-3353
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1220
AR
Other
Enumeration date
06/27/2017
Last updated
06/26/2024
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