Healthcare Provider Details

I. General information

NPI: 1942534508
Provider Name (Legal Business Name): MARY MEGAN SAVAGE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

111 N MUNN ST
WARREN AR
71671-2951
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 870-820-1098
  • Fax: 870-628-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2303
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: