Healthcare Provider Details

I. General information

NPI: 1184347007
Provider Name (Legal Business Name): BAILEY SMITH OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST STE 4
JACKSONVILLE AR
72076-4139
US

IV. Provider business mailing address

1405 ANNA SUE CIR
VAN BUREN AR
72956-2947
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax:
Mailing address:
  • Phone: 479-652-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: