Provider Demographics
NPI:1013069160
Name:WILLIAMS, BECKY RENNA (OTRL)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:RENNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:RENNA
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:5501 VILLAGE TRCE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9601
Mailing Address - Country:US
Mailing Address - Phone:501-590-7502
Mailing Address - Fax:501-847-5662
Practice Address - Street 1:200 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3424
Practice Address - Country:US
Practice Address - Phone:501-847-5660
Practice Address - Fax:501-847-5662
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118135721Medicaid