Healthcare Provider Details

I. General information

NPI: 1336377811
Provider Name (Legal Business Name): TONYA Y SKINNER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONYA Y JEFFERSON

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S LINCOLN ST
LOWELL AR
72745-9782
US

IV. Provider business mailing address

PO DRAWER 2109
RUSSELLVILLE AR
72811
US

V. Phone/Fax

Practice location:
  • Phone: 479-770-0744
  • Fax:
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-967-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR2418
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002596
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: