Organization
CREATIVE PEDIATRIC OCCUPATIONAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN KAY BRUCE OTR/L (PRESIDENT)
(479) 409-5067
Entity
Organization
Contact information
Practice address
2474 E JOYCE BLVD, SUITE 3, FAYETTEVILLE, AR 72703-4519
(479) 409-5067
(479) 521-5439
Mailing address
PO BOX 778, ELKINS, AR 72727-0778
(479) 409-5067
(479) 521-5439
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR582
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5C353
BCBS GROUP NUMBER
AR
Enumeration date
02/10/2006
Last updated
08/22/2020
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