Provider Demographics
NPI:1740610344
Name:HALTER, CONNIE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 ROLAND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9685
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20900 ROLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9685
Practice Address - Country:US
Practice Address - Phone:501-847-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist