Basic Information
| Provider Information | |||||||||
| NPI: | 1194181230 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SPOERL | ||||||||
| FirstName: | ASTOSIA | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 MCCAY DR | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723963007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703629202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3998 HIGHWAY 1 N | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723357637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706331737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2016 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OT2015-049 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.