Individual
AMANDA KATHLENE DIXON HUDDLESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
5052 W WAVERLY RD, FAYETTEVILLE, AR 72704-6957
(918) 261-4023
Mailing address
5052 W WAVERLY RD, FAYETTEVILLE, AR 72704-6957
(918) 261-4023
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
1518
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518
OKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK
01
—
OTR2862
ARKANSAS STATE MEDICAL BOARD
AR
Enumeration date
07/16/2010
Last updated
11/20/2015
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