Provider Demographics
NPI:1407050511
Name:BAUTISTA, FLORDELIZA OPLE (OTR)
Entity Type:Individual
Prefix:
First Name:FLORDELIZA
Middle Name:OPLE
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 NW YUKON TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5004
Mailing Address - Country:US
Mailing Address - Phone:479-464-8990
Mailing Address - Fax:479-271-7129
Practice Address - Street 1:112 NW YUKON TRAIL ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5004
Practice Address - Country:US
Practice Address - Phone:479-464-8990
Practice Address - Fax:479-271-7129
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1490225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation