Provider Demographics
NPI:1306975578
Name:SHOURD, CATHERINE L (OTRL)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:L
Last Name:SHOURD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 AGARITA CV
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8520
Mailing Address - Country:US
Mailing Address - Phone:501-329-4641
Mailing Address - Fax:
Practice Address - Street 1:1700 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6455
Practice Address - Country:US
Practice Address - Phone:501-329-8102
Practice Address - Fax:501-329-2113
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1133225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROTR1133OtherSTATE LICENSE NUMBER