Healthcare Provider Details

I. General information

NPI: 1063526259
Provider Name (Legal Business Name): JERRY CRILEY OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

5723 KELLY RD
NORTH LITTLE ROCK AR
72118-2012
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-6398
  • Fax: 501-257-6419
Mailing address:
  • Phone: 501-257-6398
  • Fax: 501-257-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR1527
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: