Provider Demographics
NPI:1376517276
Name:CONNELL, CASEY LINETTE (MS)
Entity Type:Individual
Prefix:MISS
First Name:CASEY
Middle Name:LINETTE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 ONEAL RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9218
Mailing Address - Country:US
Mailing Address - Phone:870-698-2918
Mailing Address - Fax:
Practice Address - Street 1:1515 HARRISON ST
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7222
Practice Address - Country:US
Practice Address - Phone:870-793-1925
Practice Address - Fax:870-793-1121
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1758225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7227677OtherAETNA INSURANCE
AR5F161OtherBLUE CROSS BLUE SHEILD