Healthcare Provider Details

I. General information

NPI: 1780588806
Provider Name (Legal Business Name): ADDISON DREA GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1699 RED WOLF BLVD STE H
JONESBORO AR
72401-5453
US

IV. Provider business mailing address

1699 RED WOLF BLVD STE H
JONESBORO AR
72401-5453
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0021
  • Fax: 501-653-4680
Mailing address:
  • Phone: 870-336-0021
  • Fax: 501-653-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A2246
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: