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NPI Code Detail

MEDICARE: MRS. JULIE RENEE MARVIN OCCUPATIONAL THERAPY

MEDICARE: MRS. JULIE RENEE MARVIN OCCUPATIONAL THERAPY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistOTR1619AR
2174400000XSpecialistNBCOT 1049924AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15W513OTHERARBCBS PROVIDER #

General Provider Information

NPI Number : 1477503639
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE RENEE MARVIN OCCUPATIONAL THERAPY
Provider Business Mailing Address
First Line : 2442 LONGWOOD ST
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-0580
Country : US
Telephone Number : 479-750-3064
Fax Number :
Provider Business Practice Location Address
First Line : 1760 N WOODLAND AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-2549
Country : US
Telephone Number : 479-443-4420
Fax Number : 479-443-0547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/09/2007

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Directions to “ MRS. JULIE RENEE MARVIN OCCUPATIONAL THERAPY” Practice Location

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