Provider Demographics
NPI:1235637810
Name:WHEELESS, TAYLOR JANE ANN (OT)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:JANE ANN
Last Name:WHEELESS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 S BOWMAN RD APT 108
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4687
Mailing Address - Country:US
Mailing Address - Phone:501-821-5459
Mailing Address - Fax:
Practice Address - Street 1:130 BROCKINGTON RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3635
Practice Address - Country:US
Practice Address - Phone:501-819-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1292224Z00000X
AROTR3431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROT-A1292OtherARKANSAS MEDICAL BOARD LICENSE NUMBER