Individual
AUTUMN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
151 SOUTHWEST DR, JONESBORO, AR 72401-5828
(870) 932-0090
(870) 930-9336
Mailing address
151 SOUTHWEST DR, JONESBORO, AR 72401-5828
(870) 932-0090
(870) 930-9336
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA 2244
AR
225X00000X
Occupational Therapist
Primary
OTR2670
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186051721
—
AR
Enumeration date
06/01/2010
Last updated
01/21/2014
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