MEDICARE: LAUREN BROOKE BIBB OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTR3395	AR

General Provider Information

NPI Number	:	1295332930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BROOKE BIBB OTD

Provider Business Mailing Address
First Line	:	3789 GRANT 53
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-8853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3789 GRANT 53
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-8853
Country	:	US
Telephone Number	:	501-940-2694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	03/02/2026

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