Healthcare Provider Details

I. General information

NPI: 1912457854
Provider Name (Legal Business Name): MELANIE ASHLEIGH BRASHERS DM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 WHITE DRIVE
BATESVILLE AR
72501
US

IV. Provider business mailing address

15 STONE CIR
BATESVILLE AR
72501-5348
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1853
  • Fax:
Mailing address:
  • Phone: 870-612-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-273
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: