Provider Demographics
NPI:1396871596
Name:SHIRLEY, ERIN B (OT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:B
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 WALDEN RD
Mailing Address - Street 2:
Mailing Address - City:CORD
Mailing Address - State:AR
Mailing Address - Zip Code:72524-9628
Mailing Address - Country:US
Mailing Address - Phone:501-450-6214
Mailing Address - Fax:
Practice Address - Street 1:1500 N HILL ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:AR
Practice Address - Zip Code:72562-9544
Practice Address - Country:US
Practice Address - Phone:501-450-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2079225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162363721Medicaid