Healthcare Provider Details

I. General information

NPI: 1558712133
Provider Name (Legal Business Name): STACY MILLIKIN MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 HARRISON ST
BATESVILLE AR
72501-7424
US

IV. Provider business mailing address

160 MCHUE RD
BATESVILLE AR
72501-8879
US

V. Phone/Fax

Practice location:
  • Phone: 870-613-3433
  • Fax: 870-569-8063
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2382
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: