Provider Demographics
NPI:1689687329
Name:PINKHAM, TERRI LYNN (OTRL)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYNN
Last Name:PINKHAM
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:281 WEDGEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730
Mailing Address - Country:US
Mailing Address - Phone:479-267-4536
Mailing Address - Fax:
Practice Address - Street 1:91 E NEAL
Practice Address - Street 2:HOPE FOR TOMORROW PEDIATRIC FOUNDATION
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730
Practice Address - Country:US
Practice Address - Phone:479-267-4673
Practice Address - Fax:479-267-4880
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U852OtherBCBS