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MRS. KIMBERLY BASS MCCORKLE OTR
Pediatrics >> Occupational Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1093011587
Individual Registrant:MRS. KIMBERLY BASS MCCORKLE OTR
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
2002 LOSTWOOD TEXARKANA, AR 71854-8194 US
Tel: 870-403-1318 Fax: --
Tel: 870-403-1318 Fax: --
Contact information for business:
2002 LOSTWOOD LANE TEXARKANA, AR 71854-2924 US
Tel: 870-403-1318 Fax: --
Tel: 870-403-1318 Fax: --
Registration Information:
NPI: 1093011587
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Occupational Therapist Pediatrics | AR | OTR 2367 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 184312721 | AR | 05 |
