Provider Demographics
NPI:1144374133
Name:CLIFFORD, ANNA MARIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:CLIFFORD
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:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-0871
Mailing Address - Country:US
Mailing Address - Phone:479-965-6752
Mailing Address - Fax:479-965-2612
Practice Address - Street 1:42 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3733
Practice Address - Country:US
Practice Address - Phone:479-965-6752
Practice Address - Fax:870-451-0222
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR861225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134104721Medicaid