Provider Demographics
NPI:1255543633
Name:WOMACK, BILL G JR (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:MR
First Name:BILL
Middle Name:G
Last Name:WOMACK
Suffix:JR
Gender:M
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 HILLRIDGE CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5937
Mailing Address - Country:US
Mailing Address - Phone:870-933-0503
Mailing Address - Fax:870-933-0503
Practice Address - Street 1:3009 HILLRIDGE CV
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5937
Practice Address - Country:US
Practice Address - Phone:870-933-0503
Practice Address - Fax:870-933-0503
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR365171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U810Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY