Provider Demographics
NPI:1295378495
Name:RAULS, CATHERINE AMANDA
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:AMANDA
Last Name:RAULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BRADLEY 16 RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-9213
Mailing Address - Country:US
Mailing Address - Phone:870-952-0019
Mailing Address - Fax:
Practice Address - Street 1:168 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4820
Practice Address - Country:US
Practice Address - Phone:870-367-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A980224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant