Individual
KELLEY HUMBARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
272 SCHOOL AVE, WEST FORK, AR 72774-3124
(479) 839-3349
(479) 839-3752
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
OTR2875
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212700721
—
AR
Enumeration date
02/19/2016
Last updated
01/18/2023
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