Individual
DIANE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 BRADLEY DR, MOUNTAIN HOME, AR 72653-2730
(870) 424-4021
Mailing address
209 ALEXANDER ST, MOUNTAIN HOME, AR 72653
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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