Provider Demographics
NPI:1194170100
Name:TILLIE STRACENER
Entity type:Organization
Organization Name:TILLIE STRACENER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRACENER
Authorized Official - Suffix:
Authorized Official - Credentials:OT-A
Authorized Official - Phone:501-281-6677
Mailing Address - Street 1:701 VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7087
Mailing Address - Country:US
Mailing Address - Phone:501-281-6677
Mailing Address - Fax:
Practice Address - Street 1:701 VALLEY CT
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7087
Practice Address - Country:US
Practice Address - Phone:501-281-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty