Provider Demographics
NPI:1134942386
Name:MCDONALD, MICHELLE (OT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 WARDEN RD STE 230
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6015
Mailing Address - Country:US
Mailing Address - Phone:501-392-9180
Mailing Address - Fax:501-392-9184
Practice Address - Street 1:6020 WARDEN RD STE 230
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6015
Practice Address - Country:US
Practice Address - Phone:501-392-9180
Practice Address - Fax:501-392-9184
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist