Healthcare Provider Details

I. General information

NPI: 1003525742
Provider Name (Legal Business Name): BLAIR ASHTON MILLER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MAIN ST
RISON AR
71665-9563
US

IV. Provider business mailing address

12910 HIGHWAY 63
RISON AR
71665-8122
US

V. Phone/Fax

Practice location:
  • Phone: 870-325-6241
  • Fax:
Mailing address:
  • Phone: 870-267-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR3737
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: