Provider Demographics
NPI:1235319112
Name:HOUSE, TABITHA KRISTA (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:KRISTA
Last Name:HOUSE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21605 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72065-8042
Mailing Address - Country:US
Mailing Address - Phone:501-425-9755
Mailing Address - Fax:
Practice Address - Street 1:21605 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:HENSLEY
Practice Address - State:AR
Practice Address - Zip Code:72065-8042
Practice Address - Country:US
Practice Address - Phone:501-425-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist