Individual
JUSTIN GABRIEL PORTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
538 N MONROE STATION DR, FAYETTEVILLE, AR 72704-7038
(479) 466-7134
Mailing address
538 N MONROE STATION DR, FAYETTEVILLE, AR 72704-7038
(479) 466-7134
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR1632
AR
Other
Enumeration date
07/30/2010
Last updated
07/30/2010
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