Healthcare Provider Details

I. General information

NPI: 1669982260
Provider Name (Legal Business Name): MARLEY JEANETTE GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CIR
NASHVILLE AR
71852-8606
US

IV. Provider business mailing address

202 PRICE RD
LOCKESBURG AR
71846-9507
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-4400
  • Fax:
Mailing address:
  • Phone: 870-584-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1205
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: