Healthcare Provider Details

I. General information

NPI: 1992915409
Provider Name (Legal Business Name): JULIANNE PATRICIA BRASWELL O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GREATHOUSE SPRINGS ROAD
JOHNSON AR
72741
US

IV. Provider business mailing address

5501 WILLOW CREEK DR STE 105
SPRINGDALE AR
72762-8707
US

V. Phone/Fax

Practice location:
  • Phone: 479-200-6555
  • Fax:
Mailing address:
  • Phone: 479-575-9359
  • Fax: 479-575-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1338
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: