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General NPI Number Information
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NPI Number | 1295918159
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Entity Type | Individual
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Provider Name | JACQUELYN MARY VANCE OCCUPATIONAL THERAPI
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Gender | Female
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1005 MAPLE DR
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-8999
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Country | US
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Telephone | 870-269-2110
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Fax | 870-269-2923
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Provider Business Mailing Address
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Address Line | PO BOX 314
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-0314
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Country | US
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Telephone | 870-656-4572
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | OTR1660
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4665
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License Number State | SC
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