Most Relevant Information
Provider Data
| NPI Number: | 1003371709 |
| Provider Name: | STAR HARBOTTLE LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/06/2019 |
| Last Updated: | 02/24/2020 |
Provider Practice Location
3111 S 70TH ST
FORT SMITH
AR
729035017
Practice Location Phone/Fax
| Phone: | 4794526650 |
| Fax: | 4794525847 |
Provider Mailing Location
PO BOX 11818
FORT SMITH
AR
729171818
Provider Mailing Phone/Fax
| Phone: | 4794526650 |
| Fax: | 4794525847 |