Individual
BROOKE ELLYN MAYCUNICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
205 OAK TREE TER, MOUNTAIN HOME, AR 72653
(870) 321-1775
Mailing address
205 OAK TREE TER, MOUNTAIN HOME, AR 72653
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1280
AR
Other
Enumeration date
10/15/2021
Last updated
10/15/2021
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