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NPI Code Detail

MEDICARE: MRS. JORDAN HERWALDT OT-A

MEDICARE:  MRS. JORDAN  HERWALDT  OT-A
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
1224Z00000XOccupational Therapy AssistantO-T1078AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1O-T1078OTHERAROT-A LICENSE

General Provider Information

NPI Number : 1639478266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JORDAN HERWALDT OT-A
Provider Business Mailing Address
First Line : 851 S DOGWOOD ST
Second Line :
City : SILOAM SPRINGS
State : AR
Zip : 72761-3915
Country : US
Telephone Number : 479-220-5361
Fax Number :
Provider Business Practice Location Address
First Line : 851 S DOGWOOD ST
Second Line :
City : SILOAM SPRINGS
State : AR
Zip : 72761-3915
Country : US
Telephone Number : 479-220-5361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2011
Last Update Date : 07/29/2024

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Directions to “ MRS. JORDAN HERWALDT OT-A” Practice Location

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