Healthcare Provider Details

I. General information

NPI: 1902710197
Provider Name (Legal Business Name): MAKEELY WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 WILLOW CREEK DR STE 101
SPRINGDALE AR
72762-0898
US

IV. Provider business mailing address

881 ROUND TOP ST
PRAIRIE GROVE AR
72753-4018
US

V. Phone/Fax

Practice location:
  • Phone: 501-445-6800
  • Fax:
Mailing address:
  • Phone: 501-286-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: