=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568744522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITNEY LEIGH BOX OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2011
-----------------------------------------------------
Last Update Date | 12/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 178 W COLLEGE ST
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-367-4333
-----------------------------------------------------
Fax | 870-367-4334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 BAYOU COVE CIR
-----------------------------------------------------
City | MC GEHEE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71654-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-367-4333
-----------------------------------------------------
Fax | 870-367-4334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0019X
-----------------------------------------------------
Taxonomy Name | Physical Rehabilitation Occupational Therapist
-----------------------------------------------------
License Number | OTR2460
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------