Provider Demographics
NPI:1942991161
Name:BUNCH, WHITLEY
Entity type:Individual
Prefix:
First Name:WHITLEY
Middle Name:
Last Name:BUNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WHITLEY
Other - Middle Name:
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3127 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8404
Mailing Address - Country:US
Mailing Address - Phone:870-932-3600
Mailing Address - Fax:
Practice Address - Street 1:120 SOUTHWINDS RD STE 120
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8652
Practice Address - Country:US
Practice Address - Phone:479-300-6400
Practice Address - Fax:479-316-0372
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3763225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist