Healthcare Provider Details

I. General information

NPI: 1639223282
Provider Name (Legal Business Name): TIARA LYN MATAIA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WATER AVE
ELM SPRINGS AR
72762-7091
US

IV. Provider business mailing address

708 W SHANE CT
SILOAM SPRINGS AR
72761-3234
US

V. Phone/Fax

Practice location:
  • Phone: 479-480-8509
  • Fax: 808-326-4063
Mailing address:
  • Phone: 808-339-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-947
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1131
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: