Provider Demographics
NPI:1891912390
Name:STARK, AIMEE ERIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:ERIN
Last Name:STARK
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 1:1306 W. COLLIN RAYE DR.
Mailing Address - Street 2:
Mailing Address - City:DEQUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832
Mailing Address - Country:US
Mailing Address - Phone:870-642-4990
Mailing Address - Fax:870-642-7250
Practice Address - Street 1:1306 W. COLLIN RAYE DR.
Practice Address - Street 2:
Practice Address - City:DEQUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832
Practice Address - Country:US
Practice Address - Phone:870-642-4990
Practice Address - Fax:870-642-7250
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1739225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148600721Medicaid