Individual
JAIMIE T WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1915 W MAIN ST, RUSSELLVILLE, AR 72801-2725
(479) 968-1198
Mailing address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-1198
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1367
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-A1367
OTA LICENSE
AR
Enumeration date
06/04/2018
Last updated
06/04/2018
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