Active NPI
Courtney Mavis Wickliffe, OT
- Occupational Therapist
- Sherwood, AR
National Provider Identifier
1497217418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3276
- Practice address
- 1540 Country Club Rd
Sherwood, AR 72120-5095 - Phone
- (501) 753-5459
- NPI assigned
- Apr 1, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 3276 | AR | Primary |
Addresses
Primary practice location
1540 Country Club Rd
Sherwood, AR 72120-5095
Mailing address
2740 College Ave
Conway, AR 72034-6141
Phone (501) 329-5459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3276 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716336000000",
"number": "1497217418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2740 COLLEGE AVE",
"city": "CONWAY",
"state": "AR",
"postal_code": "720346141",
"telephone_number": "501-329-5459",
"fax_number": "501-327-1738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 COUNTRY CLUB RD",
"city": "SHERWOOD",
"state": "AR",
"postal_code": "721205095",
"telephone_number": "501-753-5459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKLIFFE",
"first_name": "COURTNEY",
"middle_name": "MAVIS",
"name_prefix": "Mrs.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-01",
"last_updated": "2024-05-22",
"certification_date": "2024-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "3276",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherwood, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.