MEDICARE: HEATH LAND

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	224Z00000X	Occupational Therapy Assistant	OT-A1759	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	977988908	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1508535253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATH LAND

Provider Business Mailing Address
First Line	:	1118 GARLAND AVE
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 GARLAND AVE
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8218
Country	:	US
Telephone Number	:	501-765-6815
Fax Number	:

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

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/07/2021

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Directions to “ HEATH LAND ” Practice Location

Language	Start Address	Practice Location

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