Provider Demographics
NPI:1124076138
Name:CASTRO NEELY, MARIA RITCHIE (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:RITCHIE
Last Name:CASTRO NEELY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:RITCHIE
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:810 JOE BROOKS DR.
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-931-6789
Mailing Address - Fax:870-931-4363
Practice Address - Street 1:2808 FOX MEADOW LANE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-4245
Practice Address - Fax:870-931-4457
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1981225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157438721Medicaid