Provider Demographics
NPI:1740729748
Name:TALBOT, KASSI (OTR)
Entity type:Individual
Prefix:
First Name:KASSI
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-208-8989
Mailing Address - Fax:870-208-8107
Practice Address - Street 1:2233 ALBERT PIKE RD STE D
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4158
Practice Address - Country:US
Practice Address - Phone:501-359-3099
Practice Address - Fax:501-881-4334
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2536225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROTR2536OtherOT LICENSE