Provider Demographics
NPI:1104863752
Name:ROBERTS, ANITA JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JO
Last Name:ROBERTS
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 1:2435 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-9417
Mailing Address - Country:US
Mailing Address - Phone:479-361-9219
Mailing Address - Fax:
Practice Address - Street 1:1760 N WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2549
Practice Address - Country:US
Practice Address - Phone:479-443-4420
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist