Provider Demographics
NPI:1003969528
Name:MATTHEWS, KRISTI (OT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 VANDERBUILT DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-9563
Mailing Address - Country:US
Mailing Address - Phone:501-794-0751
Mailing Address - Fax:
Practice Address - Street 1:3214 WINCHESTER DR.
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-326-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1004448225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics