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Individual

MS. REGINA GERTRUDE BRANTLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
161 SUNRISE CT, MTN HOME, AR 72653
(870) 424-0909
Mailing address
161 SUNRISE CT, MOUNTAIN HOME, AR 72653-8057
(870) 424-0909

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A338
AR

Other

Enumeration date
04/05/2012
Last updated
04/05/2012
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