Provider Demographics
NPI:1962516104
Name:MAULDIN, CATHERINE DANELL (OTR/L)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DANELL
Last Name:MAULDIN
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 1:3612 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-9305
Mailing Address - Country:US
Mailing Address - Phone:501-771-7720
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DRIVE (117/NLR)
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-257-3040
Practice Address - Fax:501-257-6419
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
251694OtherNBCOT CERTIFICATION #
AR-1364-88OtherNDTA CERTIFICATION NUMBER