Individual
BRETT BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOT, OT/L
Contact information
Practice address
4497 W PECAN ST, FAYETTEVILLE, AR 72704-7909
(501) 230-2050
Mailing address
405 SW BARN VALLEY RD, BENTONVILLE, AR 72712-9378
(501) 230-2050
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OT-A1000
AR
225XP0200X
Pediatric Occupational Therapist
Primary
OT2023-028
AR
Other
Enumeration date
08/31/2015
Last updated
10/04/2023
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