Healthcare Provider Details

I. General information

NPI: 1225770894
Provider Name (Legal Business Name): LAUREN INEZ DEXTER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W POPLAR ST
ROGERS AR
72756-4242
US

IV. Provider business mailing address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

V. Phone/Fax

Practice location:
  • Phone: 479-631-7678
  • Fax:
Mailing address:
  • Phone: 479-713-8630
  • Fax: 479-713-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3544
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: