Individual
JESSICA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
306 E 11TH ST, RUSSELLVILLE, AR 72801-6156
(479) 968-1198
(479) 967-1178
Mailing address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-1198
(479) 967-1178
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
O-T1375
AR
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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