Individual
MALLORY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1801 GRANT AVE, JONESBORO, AR 72401-6155
(870) 974-9114
(870) 974-9184
Mailing address
1801 GRANT AVE, JONESBORO, AR 72401-6155
(870) 974-9114
(870) 974-9184
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1798
AR
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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