Healthcare Provider Details

I. General information

NPI: 1043344989
Provider Name (Legal Business Name): MARI-GRAY MATTHEWS OTR.L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARI GRAY SCARBROUGH OTR

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 W 34TH AVE
PINE BLUFF AR
71603-5508
US

IV. Provider business mailing address

PO BOX 251418
LITTLE ROCK AR
72225-1418
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-7392
  • Fax:
Mailing address:
  • Phone: 870-534-0667
  • Fax: 501-526-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112222
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1849
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: