Provider Demographics
NPI:1023378205
Name:FOLEY, KRISSANDRA MARIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISSANDRA
Middle Name:MARIA
Last Name:FOLEY
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 1:10 HANAH LN
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8976
Mailing Address - Country:US
Mailing Address - Phone:870-213-6350
Mailing Address - Fax:
Practice Address - Street 1:706 OAK GROVE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-8601
Practice Address - Country:US
Practice Address - Phone:870-269-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist