Individual
STACY ELAINE MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1807 W MOLINE ST, MALVERN, AR 72104-2645
(501) 467-3166
(501) 467-3161
Mailing address
913 RIVER ST, BENTON, AR 72015-5024
(501) 240-9867
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR1458
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136251721
—
AR
Enumeration date
01/16/2007
Last updated
05/13/2010
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