Healthcare Provider Details

I. General information

NPI: 1396102380
Provider Name (Legal Business Name): JESSICA MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5532 JFK BLVD
NORTH LITTLE ROCK AR
72116-6708
US

IV. Provider business mailing address

1501 S WALDRON RD STE 107
FORT SMITH AR
72903-2568
US

V. Phone/Fax

Practice location:
  • Phone: 501-588-3211
  • Fax:
Mailing address:
  • Phone: 479-462-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A906
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: