Provider Demographics
NPI:1942674007
Name:MIDDLETON, WILLIAM TAYLOR (OT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TAYLOR
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO DRAWER 2109
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-967-2322
Mailing Address - Fax:
Practice Address - Street 1:1200 S ELMIRA AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9646
Practice Address - Country:US
Practice Address - Phone:479-968-7118
Practice Address - Fax:479-968-8628
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR242631721Medicaid