Active NPI
Amanda Tristin Drake, OTR/L
- Occupational Therapist
- Jonesboro, AR
National Provider Identifier
1780907899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR2340
- Practice address
- 1220 Stone St
Jonesboro, AR 72401-4519 - Phone
- (870) 931-4200
- Fax
- (870) 931-4201
- NPI assigned
- Mar 3, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | OTR2340 | AR | Primary |
Addresses
Primary practice location
1220 Stone St
Jonesboro, AR 72401-4519
Mailing address
3840 Highway 358
Paragould, AR 72450-9691
Phone (573) 421-5516
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 |
|---|---|---|---|
| OTR2340 | AR | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267574400000",
"number": "1780907899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3840 HIGHWAY 358",
"city": "PARAGOULD",
"state": "AR",
"postal_code": "724509691",
"telephone_number": "573-421-5516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 STONE ST",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724014519",
"telephone_number": "870-931-4200",
"fax_number": "870-931-4201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "AMANDA",
"middle_name": "TRISTIN",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-03",
"last_updated": "2010-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR2340",
"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 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.