Individual
STACEY NICOLE BEARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
913 N 24TH ST, VAN BUREN, AR 72956-3743
(479) 650-5030
Mailing address
4100 S S ST, FORT SMITH, AR 72903-3446
(479) 650-5030
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1199
AR
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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