Individual provider Active NPI

Patrick Brian Cunningham, OTR/L

  • Occupational Therapist
  • Fayetteville, AR
National Provider Identifier
1871377010
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OTR3823 Issued in AR
Practice address
3317 N Wimberly Dr FL 2
Fayetteville, AR 72703-4056
Phone
(479) 587-3117
Fax
(479) 587-3185
NPI assigned
Aug 21, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OTR3823 AR Primary

Addresses

Primary practice location

3317 N Wimberly Dr FL 2
Fayetteville, AR 72703-4056

Mailing address

3317 N Wimberly Dr FL 2
Fayetteville, AR 72703-4056
Phone (479) 587-3117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231103002470 AR Practitioner - Occupational Therapist in Private Practice 7113374778 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OTR3823ARMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mountaincrest Rehab of Bella Vista, Inc. CurrentSince Oct 25, 2023 Accepting new patients
Ozark Orthopaedics, P.a. PastSince Sep 5, 2023 Accepting new patients

Locations

1801 Forest Hills Blvd
Ste 205
Bella Vista, AR 72715
Phone (479) 855-9348

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": "1692576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1871377010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3317 N WIMBERLY DR FL 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034056",
            "telephone_number": "479-587-3117",
            "fax_number": "479-587-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 N WIMBERLY DR FL 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034056",
            "telephone_number": "479-587-3117",
            "fax_number": "479-587-3185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "PATRICK",
        "middle_name": "BRIAN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AR",
            "license": "OTR3823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.