Provider Demographics
NPI:1821548769
Name:EVERITT, WILLIAM TYLER (OTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TYLER
Last Name:EVERITT
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9063
Mailing Address - Country:US
Mailing Address - Phone:318-801-8852
Mailing Address - Fax:
Practice Address - Street 1:2121 HICKORY DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-9063
Practice Address - Country:US
Practice Address - Phone:318-801-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A739224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant