Provider Demographics
NPI:1033452313
Name:JOY, WHITNEY BLAIR (COTA/L)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BLAIR
Last Name:JOY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TOWNSHIP CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3395
Mailing Address - Country:US
Mailing Address - Phone:217-313-8782
Mailing Address - Fax:
Practice Address - Street 1:610 N MISSOURI ST
Practice Address - Street 2:STE 1
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3148
Practice Address - Country:US
Practice Address - Phone:870-400-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T1300224Z00000X
MSTA2767224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant