Individual
LISA ANN EWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
816 FAYETTEVILLE RD, VAN BUREN, AR 72956-3423
(479) 629-3682
Mailing address
6524 GOINES DR, VAN BUREN, AR 72956-7920
(479) 629-3682
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1425
AR
Other
Enumeration date
03/12/2010
Last updated
08/29/2019
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