Provider Demographics
NPI:1093173221
Name:MANCHESTER, JOLINA LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOLINA
Middle Name:LYN
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JOLINA
Other - Middle Name:LYN
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:107 GREER ST
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-3104
Mailing Address - Country:US
Mailing Address - Phone:714-606-6671
Mailing Address - Fax:
Practice Address - Street 1:2510 W HUDSON RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2072
Practice Address - Country:US
Practice Address - Phone:479-936-1061
Practice Address - Fax:855-812-1132
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3780225X00000X
CAOT14727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist