Active NPI
Zachary Fendley
- Occupational Therapist
- Ward, AR
National Provider Identifier
1114397502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR2837
- Practice address
- 1500 Wilson Loop
Ward, AR 72176-8656 - Phone
- (501) 941-5630
- Fax
- (501) 353-2599
- NPI assigned
- Sep 29, 2015
- Last updated
- Oct 4, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR2837 | AR | Primary |
Addresses
Primary practice location
1500 Wilson Loop
Ward, AR 72176-8656
Mailing address
1500 Wilson Loop
Ward, AR 72176-8656
Phone (501) 941-5630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 210596721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR2837 | AR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Therapy and Consulting Services, PA | Current | Accepting new patients | |
| Beyond Boundaries, Inc | Occupational Therapist | Past | Accepting new patients |
| Arkansas Enterprises for the Developmentally Disabled, Inc. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- North Little Rock, AR
- NPI 1134185937
-
- Developmentally Disabled Services Day Training Agency
- Little Rock, AR
- NPI 1184634610
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1114397502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 WILSON LOOP",
"city": "WARD",
"state": "AR",
"postal_code": "721768656",
"telephone_number": "501-941-5630",
"fax_number": "501-353-2599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 WILSON LOOP",
"city": "WARD",
"state": "AR",
"postal_code": "721768656",
"telephone_number": "501-941-5630",
"fax_number": "501-353-2599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENDLEY",
"first_name": "ZACHARY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-29",
"last_updated": "2021-10-04",
"certification_date": "2021-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR2837",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "210596721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ward, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.