Provider Demographics
NPI:1285272450
Name:GARLAND, JONATHAN (OTD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GARLAND
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 SAVANAH HILLS DR APT 238
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7119
Mailing Address - Country:US
Mailing Address - Phone:501-207-2634
Mailing Address - Fax:
Practice Address - Street 1:4309 SAVANAH HILLS DR APT 238
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7119
Practice Address - Country:US
Practice Address - Phone:501-207-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty