Provider Demographics
NPI:1629379730
Name:BERNARD, ANGELA WHITE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:WHITE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DBA: SOUTHERN CHARM
Other - Middle Name:THERAPY
Other - Last Name:INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8109 I 30
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4840
Mailing Address - Country:US
Mailing Address - Phone:501-246-1137
Mailing Address - Fax:
Practice Address - Street 1:8109 I 30
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4840
Practice Address - Country:US
Practice Address - Phone:501-246-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225X00000X
AROTR-1748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist