Active NPI
Bryan Raymond, COTA
- Occupational Therapy Assistant
- Marion, AR
National Provider Identifier
1750435012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OT-A457
- Practice address
- 101 Brougham Ave
Marion, AR 72364-2505 - Phone
- (870) 739-9982
- NPI assigned
- Jan 23, 2007
- 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 Therapy Assistant | 224Z00000X | OT-A457 | AR | Primary |
Addresses
Primary practice location
101 Brougham Ave
Marion, AR 72364-2505
Mailing address
707 Eldridge Ave E
Wynne, AR 72396-4032
Phone (870) 208-8989
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 |
|---|---|---|---|
| OT-A457 | AR | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boaz & Associates, Inc. | 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.
-
- Physical Therapy Clinic/Center
- Wynne, AR
- NPI 1518011816
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1750435012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 ELDRIDGE AVE E",
"city": "WYNNE",
"state": "AR",
"postal_code": "723964032",
"telephone_number": "870-208-8989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 BROUGHAM AVE",
"city": "MARION",
"state": "AR",
"postal_code": "723642505",
"telephone_number": "870-739-9982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYMOND",
"first_name": "BRYAN",
"name_prefix": "Mr.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OT-A457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.