Healthcare Provider Details

I. General information

NPI: 1508817479
Provider Name (Legal Business Name): GRETCHEN B GARRISON OCCUPATIONAL THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N THOMPSON ST
SPRINGDALE AR
72764-4118
US

IV. Provider business mailing address

12020 CHURCHILL DOWNS
ELM SPRINGS AR
72762-4231
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-8880
  • Fax:
Mailing address:
  • Phone: 479-466-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNBCOT 1031924
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1472
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOTR1472
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: