Individual
NIKKI SUMMERVILLE STIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
705 W COLLEGE AVE, BERRYVILLE, AR 72616-3105
(870) 423-6122
Mailing address
8 TWIN PEAK DR, HOLIDAY ISLAND, AR 72631-4233
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A952
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206702795
—
AR
Enumeration date
08/18/2015
Last updated
06/09/2022
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