1184745549 NPI number — MARY HEBERT O.T.R.

Table of content: MARY HEBERT O.T.R. (NPI 1184745549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184745549 NPI number — MARY HEBERT O.T.R.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEBERT
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.R.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REINBOLT
Provider Other First Name:
MARY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184745549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 E LOVERS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72701-2831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-973-9205
Provider Business Mailing Address Fax Number:
479-973-9205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HALSTED CIR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72756-3185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-466-4237
Provider Business Practice Location Address Fax Number:
479-973-9205
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OTR1018 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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