Provider Demographics
NPI:1629524236
Name:FAULKNER, ANNA ELIZABETH (OT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 CATHOLIC POINT RD
Mailing Address - Street 2:
Mailing Address - City:CENTER RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72027-8403
Mailing Address - Country:US
Mailing Address - Phone:501-208-7640
Mailing Address - Fax:
Practice Address - Street 1:1025 CATHOLIC POINT RD
Practice Address - Street 2:
Practice Address - City:CENTER RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72027-8403
Practice Address - Country:US
Practice Address - Phone:501-208-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist