Provider Demographics
NPI:1437675261
Name:WRIGHT, MIKAYLA GRACE
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:GRACE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71845-8643
Mailing Address - Country:US
Mailing Address - Phone:870-904-4161
Mailing Address - Fax:
Practice Address - Street 1:1907 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71845-8643
Practice Address - Country:US
Practice Address - Phone:870-904-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant