Individual
JAYLIN BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 WILSON LOOP, WARD, AR 72176-8656
(501) 588-3211
(501) 353-2599
Mailing address
1500 WILSON LOOP, WARD, AR 72176-8656
(501) 588-3211
(501) 353-2599
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1507
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
234095721
—
AR
Enumeration date
06/25/2019
Last updated
07/08/2019
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