Amanda Balentine-Depriest, MS, OTR/L
Individual provider Active NPI Occupational Therapist · North Little Rock, AR
NPI 1104151802 · NPPES record last updated Aug 20, 2018
Key facts
- NPI
- 1104151802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OTR2268 (AR)
- Practice address
- 4801 Fairway Ave
North Little Rock, AR 72116 - Phone
- (501) 758-1300
- NPI assigned
- Oct 14, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Arkansas Rehabilitation Experts
Practice addresses (Care Compare)
6020 Warden Rd
Suite 230
Sherwood, AR 72120-6015
Phone (501) 392-9180
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181009000823 | AR | Practitioner - Occupational Therapist in Private Practice | 3173875812 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR2268 | AR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harris & Renshaw Rehab Center, Inc. | Occupational Therapist | Current |
Accepting new patients |
| Central Arkansas Rehabilitation Experts | Occupational Therapist | Current |
Accepting new patients |
Locations
4801 Fairway Ave
North Little Rock, AR 72116
Phone (501) 687-0328
6020 Warden Rd
Ste 230
Sherwood, AR 72120
Phone (501) 392-9180
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR2268 | AR | Yes |
Addresses
Primary practice location
4801 Fairway Ave
North Little Rock, AR 72116
Mailing address
411 Hayley CT
Sherwood, AR 72120-9681
Phone (870) 307-7615
Other practice location 1
3920 Woodland Heights Rd
Little Rock, AR 72212-2495
Phone (501) 227-3600
Other providers in North Little Rock, AR
- Lorie Ann Baker
- Polly Fair Baker
- Shundrea L Baker
- Samantha Baldwin
- April S Bale
- Reed Balentine
- Lauren Katherine Ballard
- Michael Charles Ballard
- Rohitha Bandla
- Thomas Banh
All providers in North Little Rock, AR · Occupational Therapist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.