Provider Demographics
NPI:1265693923
Name:MCCARRON, EMILY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:MCCARRON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GLENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9251
Mailing Address - Country:US
Mailing Address - Phone:501-733-2166
Mailing Address - Fax:
Practice Address - Street 1:1164 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173
Practice Address - Country:US
Practice Address - Phone:501-796-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140710721Medicaid