Provider Demographics
NPI:1518912856
Name:CARDEN, MANDIE DAWN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MANDIE
Middle Name:DAWN
Last Name:CARDEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13907 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-7216
Mailing Address - Country:US
Mailing Address - Phone:501-257-3221
Mailing Address - Fax:501-257-3110
Practice Address - Street 1:2200 FORT ROOTS DR 116 /NLR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:501-257-3110
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148140721Medicaid