Provider Demographics
NPI:1154696342
Name:BULLARD, CULLEN CHRISTOPHER (OTR/L)
Entity type:Individual
Prefix:
First Name:CULLEN
Middle Name:CHRISTOPHER
Last Name:BULLARD
Suffix:
Gender:M
Credentials:OTR/L
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 3250
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-3250
Mailing Address - Country:US
Mailing Address - Phone:501-315-0984
Mailing Address - Fax:501-847-1405
Practice Address - Street 1:105 MCNEIL ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3345
Practice Address - Country:US
Practice Address - Phone:501-315-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist