Provider Demographics
NPI:1578200770
Name:HURTADO, VIRIDIANA (OT-A)
Entity type:Individual
Prefix:MRS
First Name:VIRIDIANA
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:OT-A
Other - Prefix:MISS
Other - First Name:VIRIDIANA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:113 S BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8448
Mailing Address - Country:US
Mailing Address - Phone:479-770-3561
Mailing Address - Fax:
Practice Address - Street 1:1000 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4242
Practice Address - Country:US
Practice Address - Phone:479-631-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1840224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant