Provider Demographics
NPI:1306955489
Name:ROYAL, DEBBIE (OTR L)
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:
Last Name:ROYAL
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 1:1794 MADISON 7750
Mailing Address - Street 2:
Mailing Address - City:HINDSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72738
Mailing Address - Country:US
Mailing Address - Phone:479-456-7116
Mailing Address - Fax:479-582-2746
Practice Address - Street 1:48 W COLT SQUARE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2813
Practice Address - Country:US
Practice Address - Phone:479-582-2740
Practice Address - Fax:479-582-2746
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1879225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124040721Medicaid