Active NPI
William Bradley Vandiver
- Occupational Therapy Assistant
- Benton, AR
National Provider Identifier
1861035941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA1464
- Practice address
- 17706 Interstate 30 N Ste 3
Benton, AR 72019-2930 - Phone
- (501) 315-4414
- NPI assigned
- Oct 22, 2019
- Sex
- Male
- 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 Therapy Assistant | 224Z00000X | OTA1464 | AR | Primary |
Addresses
Primary practice location
17706 Interstate 30 N Ste 3
Benton, AR 72019-2930
Mailing address
17706 Interstate 30 N Ste 3
Benton, AR 72019-2930
Phone (501) 315-4414
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 |
|---|---|---|---|
| OTA1464 | AR | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kid Success, 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.
-
- Rehabilitation Clinic/Center
- Conway, AR
- NPI 1609997311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1861035941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17706 INTERSTATE 30 N STE 3",
"city": "BENTON",
"state": "AR",
"postal_code": "720192930",
"telephone_number": "501-315-4414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17706 INTERSTATE 30 N STE 3",
"city": "BENTON",
"state": "AR",
"postal_code": "720192930",
"telephone_number": "501-315-4414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDIVER",
"first_name": "WILLIAM",
"middle_name": "BRADLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-22",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OTA1464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.