Healthcare Provider Details

I. General information

NPI: 1225189186
Provider Name (Legal Business Name): BRANDY JOINER MS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 COLLEGE AVENUE
CONWAY AR
72034-9310
US

IV. Provider business mailing address

425 WEDGEWOOD PT
CONWAY AR
72034-7567
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-5459
  • Fax: 501-325-1378
Mailing address:
  • Phone: 501-336-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1931
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: