Provider Demographics
NPI:1437116027
Name:JARVIS, WENDY LEE (OTR L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 ELM SPRINGS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2703
Mailing Address - Country:US
Mailing Address - Phone:479-750-7778
Mailing Address - Fax:479-750-7708
Practice Address - Street 1:3896 ELM SPRINGS RD
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2703
Practice Address - Country:US
Practice Address - Phone:479-750-7778
Practice Address - Fax:479-750-7708
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T840OtherBC/BS ID NUMBER
AR155431742Medicaid