Individual
MRS. LYNETTE BOOTH WHEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2474 E JOYCE BLVD, FAYETTEVILLE, AR 72703-4519
(479) 521-8326
Mailing address
2474 E JOYCE BLVD STE 2, FAYETTEVILLE, AR 72703-4932
(479) 521-8326
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
OTR1083
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136256721
—
AR
01
—
5Y909
BLUE CROSS BLUE SHIELD
AR
Enumeration date
03/14/2007
Last updated
05/15/2024
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