Provider Demographics
NPI:1801046081
Name:BUSSARD, BRIAN (OT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BUSSARD
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HICKORY BEND DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8183
Mailing Address - Country:US
Mailing Address - Phone:501-941-2231
Mailing Address - Fax:
Practice Address - Street 1:1975 WHITE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9391
Practice Address - Country:US
Practice Address - Phone:870-698-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist