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General NPI Number Information
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NPI Number | 1215361415
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Entity Type | Individual
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Provider Name | MICHAEL WOOLDRIDGE OT-A
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Gender | Male
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Dates
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Enumeration Date | 08/25/2013
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Last Update Date | 08/25/2013
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Provider Practice Location Address
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Address Line | 3434 ONE PL
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City | JONESBORO
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State | AR
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Zip | 72404-9335
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Country | US
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Telephone | 870-283-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 40 GABRIEL WAY
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City | SULPHUR ROCK
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State | AR
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Zip | 72579-9012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OT-A792
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License Number State | AR
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