Provider Demographics
NPI:1215082912
Name:WALDEN, KARI (COTA)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 JFK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6708
Mailing Address - Country:US
Mailing Address - Phone:501-588-3211
Mailing Address - Fax:501-353-2599
Practice Address - Street 1:1500 WILSON LOOP
Practice Address - Street 2:
Practice Address - City:WARD
Practice Address - State:AR
Practice Address - Zip Code:72176-8656
Practice Address - Country:US
Practice Address - Phone:501-588-3211
Practice Address - Fax:501-843-2270
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0652224Z00000X
AROT-A486224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162629731Medicaid