Provider Demographics
NPI:1376314013
Name:DICKSON, SHAYLA BRIANNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:BRIANNE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72437-9707
Mailing Address - Country:US
Mailing Address - Phone:870-810-4105
Mailing Address - Fax:
Practice Address - Street 1:148 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4077
Practice Address - Country:US
Practice Address - Phone:870-520-8761
Practice Address - Fax:870-573-8133
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist