Individual provider Active NPI

Maranda Light, OTA

  • Occupational Therapy Assistant
  • Jonesboro, AR
National Provider Identifier
1649872136
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OT-A1170 Issued in AR
Practice address
1801 Grant Ave
Jonesboro, AR 72401-6155
Phone
(870) 974-9114
NPI assigned
Nov 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OT-A1170 AR Primary

Addresses

Primary practice location

1801 Grant Ave
Jonesboro, AR 72401-6155

Mailing address

1801 Grant Ave
Jonesboro, AR 72401-6155
Phone (870) 974-9114

Other practice location 1

321 SW 3rd St
Walnut Ridge, AR 72476-2308
Phone (870) 637-5903

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

LicenseStateTypeSpecialty
OT-A1170ARMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kidspot Jackson County Inc PastSince Sep 5, 2023 Accepting new patients
Kidspot Jackson County Inc PastSince Jan 1, 2023 Accepting new patients

Organizations & group practices 2

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": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1649872136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 GRANT AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016155",
            "telephone_number": "870-974-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 GRANT AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016155",
            "telephone_number": "870-974-9114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 SW 3rd St",
            "address_purpose": "LOCATION",
            "city": "Walnut Ridge",
            "state": "AR",
            "postal_code": "724762308",
            "country_code": "US",
            "telephone_number": "870-637-5903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "MARANDA",
        "credential": "OTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-10",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A1170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.

Verify at the official NPI Registry.