| NPI | 1750593828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAGENA KAY IMMEL Occupational Therapist 479-754-2107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: AR OTR1512) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |