Healthcare Provider Details

I. General information

NPI: 1639538762
Provider Name (Legal Business Name): LINDSEY MARIE GRAY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 HAWKINS DR
SEARCY AR
72143-4802
US

IV. Provider business mailing address

2918 HAWKINS DR
SEARCY AR
72143-4802
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-9255
  • Fax:
Mailing address:
  • Phone: 501-279-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR2874
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: