Individual
STEPHANIE TIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1700 SOUTH BLVD, CONWAY, AR 72034-6455
(501) 329-8102
Mailing address
1700 SOUTH BLVD, CONWAY, AR 72034-6455
(501) 329-8102
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1641
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175509795
—
AR
Enumeration date
04/17/2008
Last updated
04/03/2009
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