Individual
MRS. MALLORY BROOKE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
403 S REYNOLDS RD, BRYANT, AR 72022-3711
(501) 776-0691
Mailing address
403 S REYNOLDS RD, BRYANT, AR 72022-3711
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A2067
AR
Other
Enumeration date
06/07/2025
Last updated
06/07/2025
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