Individual
MRS. MIRANDA MASSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 WILSON LOOP, WARD, AR 72176-8656
(501) 588-3211
Mailing address
21 W PLAZA BLVD, CABOT, AR 72023-3754
(501) 743-6460
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT0000004364
TN
225X00000X
Occupational Therapist
Primary
OTR2077
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163340721
—
AR
Enumeration date
02/26/2007
Last updated
07/11/2016
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