Provider Demographics
NPI:1639463052
Name:BATHULA, MANJULA ROBERT (OTA)
Entity Type:Individual
Prefix:
First Name:MANJULA
Middle Name:ROBERT
Last Name:BATHULA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 W BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6304
Mailing Address - Country:US
Mailing Address - Phone:501-279-7727
Mailing Address - Fax:501-279-7728
Practice Address - Street 1:704 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6304
Practice Address - Country:US
Practice Address - Phone:501-279-7727
Practice Address - Fax:501-279-7728
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A380224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant