Provider Demographics
NPI:1609889344
Name:MULLINS, MEAGAN LEIGH (OTRL)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:LEIGH
Last Name:MULLINS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1608
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1608
Mailing Address - Country:US
Mailing Address - Phone:479-587-3130
Mailing Address - Fax:
Practice Address - Street 1:1101 HORSEBARN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8237
Practice Address - Country:US
Practice Address - Phone:479-271-4170
Practice Address - Fax:479-271-8095
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR14835071Medicaid
AR5Y570OtherBCBS
ARP00363343OtherRAILROAD MEDICARE NUMBER