Basic Information
| Provider Information | |||||||||
| NPI: | 1407250236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAASS | ||||||||
| FirstName: | WILL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 389 LAKE HAMILTON DR APT F17 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632104496 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | ARKADELPHIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702305426 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2014 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | AT 634 | AR | Y | Other Service Providers | Contractor |
No ID Information.