Individual
SHELLY R STATTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 NW 4TH ST, BRYANT, AR 72022-3424
(501) 847-5660
Mailing address
1200 OXFORD AVE, BENTON, AR 72019-2664
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1529
AR
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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