Healthcare Provider Details

I. General information

NPI: 1659556827
Provider Name (Legal Business Name): MARSHA DELL DESILLAS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 CREST LN
SPRINGDALE AR
72762-9336
US

IV. Provider business mailing address

2474 E JOYCE BLVD STE. 2
FAYETTEVILLE AR
72703-4519
US

V. Phone/Fax

Practice location:
  • Phone: 479-248-1112
  • Fax:
Mailing address:
  • Phone: 479-521-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR-2130
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: