Provider Demographics
NPI:1760165898
Name:SPRADLIN, SHONNA MICHELLE
Entity Type:Individual
Prefix:
First Name:SHONNA
Middle Name:MICHELLE
Last Name:SPRADLIN
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 1:2550 PEABODY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2314
Mailing Address - Country:US
Mailing Address - Phone:501-269-1919
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTHRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-8853
Practice Address - Country:US
Practice Address - Phone:501-362-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist