Provider Demographics
NPI:1215534508
Name:KEATON, BAILEY MARIE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:MARIE
Last Name:KEATON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 INDIAN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8267
Mailing Address - Country:US
Mailing Address - Phone:501-303-8998
Mailing Address - Fax:
Practice Address - Street 1:1500 N MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5851
Practice Address - Country:US
Practice Address - Phone:501-217-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty