Provider Demographics
NPI:1073711016
Name:HUMMERT, JEFFREY LOUIS (OTA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOUIS
Last Name:HUMMERT
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RECTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72461-1527
Mailing Address - Country:US
Mailing Address - Phone:870-930-6269
Mailing Address - Fax:
Practice Address - Street 1:1009 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RECTOR
Practice Address - State:AR
Practice Address - Zip Code:72461-1527
Practice Address - Country:US
Practice Address - Phone:870-930-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant