Provider Demographics
NPI:1275178113
Name:STARK, CATHRYN ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:ELIZABETH
Last Name:STARK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 LYON LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8281
Mailing Address - Country:US
Mailing Address - Phone:479-250-9838
Mailing Address - Fax:
Practice Address - Street 1:1268 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7498
Practice Address - Country:US
Practice Address - Phone:479-750-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3336225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics