Provider Demographics
NPI:1689142515
Name:HORTON, EDDY MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:EDDY
Middle Name:MARIE
Last Name:HORTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GREEN THUMB DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-7951
Mailing Address - Country:US
Mailing Address - Phone:870-448-7989
Mailing Address - Fax:
Practice Address - Street 1:1810 OZARKA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6455
Practice Address - Country:US
Practice Address - Phone:870-269-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist