Healthcare Provider Details

I. General information

NPI: 1558516831
Provider Name (Legal Business Name): JONI D MCGHEE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2008
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CIRCLE
NASHVILLE AR
71852
US

IV. Provider business mailing address

PO BOX 657 478 GREENE ROAD
DIERKS AR
71833-0657
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-8161
  • Fax: 870-845-8284
Mailing address:
  • Phone: 832-651-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106926
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTR2569
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: