Provider Demographics
NPI:1871305904
Name:MINTON, ADRIANA MAE-LYN
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:MAE-LYN
Last Name:MINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 E JOHNSON AVE APT D11
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-1951
Mailing Address - Country:US
Mailing Address - Phone:573-625-9131
Mailing Address - Fax:
Practice Address - Street 1:130 UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-9751
Practice Address - Country:US
Practice Address - Phone:501-230-3100
Practice Address - Fax:501-882-9825
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant