Individual
CARLY PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1501 W COURT ST, PARAGOULD, AR 72450-4025
(870) 240-6247
Mailing address
783 GREENE 632 RD, PARAGOULD, AR 72450-8525
(870) 240-6247
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A878
AR
Other
Enumeration date
07/25/2014
Last updated
06/28/2024
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