Individual
MRS. AMANDA ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
121 COX ST, BENTON, AR 72015-4611
(501) 776-0691
(501) 776-0692
Mailing address
121 COX ST, P.O. BOX 368, BENTON, AR 72015-4611
(501) 776-0691
(501) 776-0692
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR1621
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143678721
—
AR
Enumeration date
03/23/2006
Last updated
09/04/2009
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