Healthcare Provider Details

I. General information

NPI: 1912064395
Provider Name (Legal Business Name): MARCUS HUTTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 YELLOWJACKET LN
CLINTON AR
72031-6873
US

IV. Provider business mailing address

17391 HIGHWAY 65 S
DAMASCUS AR
72039-8913
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-6034
  • Fax:
Mailing address:
  • Phone: 501-514-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOTR1762
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1762
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: