Provider Demographics
NPI:1871263434
Name:GARRETSON, RICHARD (OT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GARRETSON
Suffix:
Gender:M
Credentials:OT
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 2384
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-2384
Mailing Address - Country:US
Mailing Address - Phone:888-384-8639
Mailing Address - Fax:
Practice Address - Street 1:10500 W MARKHAM ST STE 109
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2187
Practice Address - Country:US
Practice Address - Phone:888-384-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2021-022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist