Individual
CASONDRA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3918 PECAN GROVE RD, RUDY, AR 72952-9026
(479) 632-6337
(479) 632-5916
Mailing address
945 E MAIN ST, BOONEVILLE, AR 72927-3843
(479) 632-6337
(479) 632-5916
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2010
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y749
BLUE CROSS BS PROV #
AR
Enumeration date
07/06/2006
Last updated
07/09/2007
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