Provider Demographics
NPI:1962092288
Name:MILLARD, EMILY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MILLARD
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARLIN LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-1610
Mailing Address - Country:US
Mailing Address - Phone:417-389-4108
Mailing Address - Fax:
Practice Address - Street 1:2 MARLIN LN
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-1610
Practice Address - Country:US
Practice Address - Phone:417-389-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3414225X00000X
MO2020029826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty