Healthcare Provider Details

I. General information

NPI: 1811504996
Provider Name (Legal Business Name): ELIZABETH CLAIRE BRANTLEY OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INNWOOD CIR STE A
LITTLE ROCK AR
72211-2490
US

IV. Provider business mailing address

8720 SPRINGHILL RD
ALEXANDER AR
72002-8436
US

V. Phone/Fax

Practice location:
  • Phone: 501-993-8707
  • Fax: 501-223-8075
Mailing address:
  • Phone: 501-366-6175
  • 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: