Provider Demographics
NPI:1114126422
Name:MITCHELLE, JOCELYN MAE (OT)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MAE
Last Name:MITCHELLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1586
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-1586
Mailing Address - Country:US
Mailing Address - Phone:479-462-3177
Mailing Address - Fax:
Practice Address - Street 1:1210 ANNA SUE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2948
Practice Address - Country:US
Practice Address - Phone:479-462-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0717225X00000X
OKAOT1539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist