Active NPI
Lance Edward Vestal, OT
- Occupational Therapist
- Rogers, AR
National Provider Identifier
1528039088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR987
- Practice address
- 3625 W Chestnut St
Rogers, AR 72756 - Phone
- (479) 631-3955
- Fax
- (479) 631-0152
- NPI assigned
- Jan 31, 2006
- Sex
- Male
- 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 | OTR987 | AR | Primary |
Addresses
Primary practice location
3625 W Chestnut St
Rogers, AR 72756
Mailing address
908 NW 8TH St
Bentonville, AR 72712
Phone (479) 273-1141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00139314 | Other | AR | RRMC |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTR987 | AR | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hill & Ironside LTD | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204761600000",
"number": "1528039088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 NW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "72712",
"telephone_number": "479-273-1141",
"fax_number": "479-273-3762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3625 W CHESTNUT ST",
"city": "ROGERS",
"state": "AR",
"postal_code": "72756",
"telephone_number": "479-631-3955",
"fax_number": "479-631-0152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VESTAL",
"first_name": "LANCE",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2008-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR987",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRMC",
"identifier": "P00139314",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.