Healthcare Provider Details

I. General information

NPI: 1386235646
Provider Name (Legal Business Name): RACHEL TINER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 KINYON RD
CENTERTON AR
72719-8936
US

IV. Provider business mailing address

2210 KINYON RD
CENTERTON AR
72719-8936
US

V. Phone/Fax

Practice location:
  • Phone: 417-848-1896
  • Fax: 866-306-2986
Mailing address:
  • Phone: 417-848-1896
  • Fax: 866-306-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3490
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: