Healthcare Provider Details

I. General information

NPI: 1295332930
Provider Name (Legal Business Name): LAUREN BROOKE BIBB OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3789 GRANT 53
HENSLEY AR
72065-8853
US

IV. Provider business mailing address

3789 GRANT 53
HENSLEY AR
72065-8853
US

V. Phone/Fax

Practice location:
  • Phone: 501-940-2694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3395
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: