Healthcare Provider Details

I. General information

NPI: 1871559534
Provider Name (Legal Business Name): JAMES COREY COLBERT OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MARKET ST STE 100
ROGERS AR
72758-8163
US

IV. Provider business mailing address

PO BOX 1398
LOWELL AR
72745-1398
US

V. Phone/Fax

Practice location:
  • Phone: 479-770-5655
  • Fax: 479-770-5656
Mailing address:
  • Phone: 479-770-5655
  • Fax: 479-770-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1941
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: