Provider Demographics
NPI:1306445804
Name:WHITEHURST, ELIZABETH (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COUNTRY OAK DR
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-7003
Mailing Address - Country:US
Mailing Address - Phone:870-323-2686
Mailing Address - Fax:
Practice Address - Street 1:2220 S WALDRON RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3733
Practice Address - Country:US
Practice Address - Phone:479-434-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist