Mallory Wilson, OTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

1798 Issued in AR

Practice address

1801 Grant Ave
Jonesboro, AR 72401-6155

Phone

(870) 974-9114

Fax

(870) 974-9184

NPI assigned

Jan 5, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1982365615",
    "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",
            "fax_number": "870-974-9184"
        },
        {
            "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",
            "fax_number": "870-974-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MALLORY",
        "credential": "OTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "1798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "a.rottinghaus@kidspotnea.com",
            "affiliation": "N",
            "endpointDescription": "a.rottinghaus@kidspotnea.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "Kidspot",
            "address_2": "1801 Grant Ave",
            "city": "Jonesboro",
            "state": "AR",
            "country_code": "US",
            "postal_code": "72401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelly Wilson, MHPP
• Kimberly L Wilson
• Latisha Wilson, MHPP
• Leigh Ann Wilson, LMSW
• Lori J Wilson, MHPP
• Matt Wilson
• Myla Marie Wilson, RN
• Nicholas K Wilson, MHPP
• Regina Wilson
• Sarah Nicole Wilson, LAC

• Occupational Therapy Assistant in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; 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.