Individual
STACEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
413 W TYLER AVE, WEST MEMPHIS, AR 72301-4149
(870) 733-1200
Mailing address
413 W TYLER AVE, WEST MEMPHIS, AR 72301-4149
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2238
AR
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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