Alan Glenn Daugherty, OTR/L

Key facts

NPI

1508496019

Entity type

Individual (NPI type 1)

Primary specialty

Gerontology Occupational Therapist 225XG0600X

License

OT1323 (AR)

Practice address

2701 Twin Rivers Dr
Arkadelphia, AR 71923-4211

Phone

(879) 246-5566

NPI assigned

Jan 23, 2020

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 23, 2020.

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1508496019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARKLAND RD",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719132516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 TWIN RIVERS DR",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719234211",
            "telephone_number": "879-246-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "ALAN",
        "middle_name": "GLENN",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "AR",
            "license": "OT1323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Arkadelphia, AR · Gerontology Occupational Therapist in Arkansas