Individual
AMY LEA FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
540 MOUDY RD, BELLEVILLE, AR 72824-8816
(479) 857-0532
(479) 495-3617
Mailing address
PO BOX 232, MOUNTAIN VIEW, AR 72560-0232
(479) 857-0532
(479) 495-2622
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OT1315
AR
225X00000X
Occupational Therapist
Primary
OT2023-001
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT1315
ARKANSAS LIC
AR
Enumeration date
08/02/2013
Last updated
01/17/2023
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