Individual
WILLIAM BRADLEY VANDIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17706 INTERSTATE 30 N STE 3, BENTON, AR 72019-2930
(501) 315-4414
Mailing address
17706 INTERSTATE 30 N STE 3, BENTON, AR 72019-2930
(501) 315-4414
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA1464
AR
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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