Provider Demographics
NPI:1346396504
Name:BOMAR, KATRINA ELIZABETH (OTR)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ELIZABETH
Last Name:BOMAR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ELIZABETH
Other - Last Name:KURCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8946
Mailing Address - Country:US
Mailing Address - Phone:501-230-8964
Mailing Address - Fax:
Practice Address - Street 1:220 GRAVEL HILL RD
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8946
Practice Address - Country:US
Practice Address - Phone:501-230-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1327225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T815OtherOCCUPATIONAL THERAPIST