=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659955250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOYOUS OT, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2021
-----------------------------------------------------
Last Update Date | 12/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 S PULASKI ST
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72201-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-1788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 JOHNSON ST
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-664-1788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COTA
-----------------------------------------------------
Name | EMILY BROWN
-----------------------------------------------------
Credential | COTA
-----------------------------------------------------
Telephone | 501-664-1788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------