Provider Demographics
NPI:1841632411
Name:GEORGE, JOSEPH MARION (OTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARION
Last Name:GEORGE
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BURCHWOOD BAY RD APT 24
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7184
Mailing Address - Country:US
Mailing Address - Phone:501-282-9674
Mailing Address - Fax:
Practice Address - Street 1:1625 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5600
Practice Address - Country:US
Practice Address - Phone:501-337-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T1321224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant