Healthcare Provider Details

I. General information

NPI: 1013307321
Provider Name (Legal Business Name): ANGELA JOINER OTA/TL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 BYRUM RD
BLYTHEVILLE AR
72315-8033
US

IV. Provider business mailing address

1510 BYRUM RD
BLYTHEVILLE AR
72315-8033
US

V. Phone/Fax

Practice location:
  • Phone: 870-532-2600
  • Fax:
Mailing address:
  • Phone: 870-532-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: