Provider Demographics
NPI:1891745204
Name:CLINTON, ERICA ASHLEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:ASHLEY
Last Name:CLINTON
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 1:476 CHIP DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL HEIGHTS
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8201
Mailing Address - Country:US
Mailing Address - Phone:502-468-3284
Mailing Address - Fax:
Practice Address - Street 1:1000 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4242
Practice Address - Country:US
Practice Address - Phone:479-621-8500
Practice Address - Fax:479-621-8506
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1967225X00000X
KYKY-R3065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y305OtherBLUE CROSS BLUE SHIELD #