Healthcare Provider Details

I. General information

NPI: 1437423779
Provider Name (Legal Business Name): CHRISTI BRENNAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 E JOYCE BLVD STE 2
FAYETTEVILLE AR
72703-4932
US

IV. Provider business mailing address

2474 E JOYCE BLVD STE 2
FAYETTEVILLE AR
72703-4932
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8326
  • Fax:
Mailing address:
  • Phone: 479-521-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR2497
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: