Provider Demographics
NPI:1033410402
Name:WHITEHEAD, CHAD (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:WHITEHEAD
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 1:3423 E HIGHLAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6404
Mailing Address - Country:US
Mailing Address - Phone:870-336-0021
Mailing Address - Fax:870-336-0022
Practice Address - Street 1:3423 E HIGHLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6404
Practice Address - Country:US
Practice Address - Phone:870-336-0021
Practice Address - Fax:870-336-0022
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist