Provider Demographics
NPI:1194701185
Name:ADAMOS, REMEDIOS MAGTOTO (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:REMEDIOS
Middle Name:MAGTOTO
Last Name:ADAMOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 JADE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-1864
Mailing Address - Country:US
Mailing Address - Phone:870-715-2705
Mailing Address - Fax:
Practice Address - Street 1:197 S. WALMART DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1984
Practice Address - Country:US
Practice Address - Phone:870-715-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149139721Medicaid
AR5X245OtherBLUE CROSS BLUE SHIELD
AR5X245OtherBLUE CROSS BLUE SHIELD