Individual
MRS. AMANDA BROOK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
11517 KANIS RD, LITTLE ROCK, AR 72211-3724
(501) 993-7171
Mailing address
26 SERENITY LN, MAYFLOWER, AR 72106-9420
(501) 584-3468
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OTR2392
AR
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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