Healthcare Provider Details

I. General information

NPI: 1255152807
Provider Name (Legal Business Name): JESSLYNN M PITCHFORD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MEDICAL CIR STE 300
NASHVILLE AR
71852-8609
US

IV. Provider business mailing address

132 MEDICAL CIR STE 300
NASHVILLE AR
71852-8609
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-8161
  • Fax: 870-845-8284
Mailing address:
  • Phone: 870-845-8161
  • Fax: 870-845-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR3920
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: