Provider Demographics
NPI:1588828677
Name:WRIGHT, JORDAN JACKSON
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:JACKSON
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 1:2694 GOURDNECK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-8381
Mailing Address - Country:US
Mailing Address - Phone:501-844-7169
Mailing Address - Fax:
Practice Address - Street 1:2837 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8321
Practice Address - Country:US
Practice Address - Phone:501-262-1724
Practice Address - Fax:501-262-6227
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant