Individual
MICAH SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 NW 4TH STREET, BRYANT, AR 72022
Mailing address
7720 SHADY ACRES CIR, HENSLEY, AR 72065-9689
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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