Provider Demographics
NPI:1790933844
Name:WHITEAKER, TYLER R (OTR/L)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:R
Last Name:WHITEAKER
Suffix:
Gender:M
Credentials: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:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543
Mailing Address - Country:US
Mailing Address - Phone:501-365-3927
Mailing Address - Fax:501-365-3914
Practice Address - Street 1:1008 HWY 25 B
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543
Practice Address - Country:US
Practice Address - Phone:501-365-3927
Practice Address - Fax:501-365-3914
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166345721Medicaid