Provider Demographics
NPI:1417590522
Name:JORDAN, TINCY (OT)
Entity Type:Individual
Prefix:
First Name:TINCY
Middle Name:
Last Name:JORDAN
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 1:494 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-3818
Mailing Address - Country:US
Mailing Address - Phone:318-235-7498
Mailing Address - Fax:
Practice Address - Street 1:494 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-3818
Practice Address - Country:US
Practice Address - Phone:318-235-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist