Jackson, Amanda Elizabeth

Jackson, Amanda Elizabeth is an individual health care provider with primary practice located at 121 Cox St , Benton AR 72015-4611. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Jackson, Amanda Elizabeth can be contacted via phone (501) 776-0691.

Contact Information

Primary practice address
121 Cox St Benton AR 72015-4611
Phone: (501) 776-0691
Fax: (501) 776-0692
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X OTR1621 Arkansas

Profile Details

NPI number 1861452112
LBN Legal business name Jackson, Amanda Elizabeth
Credentials OTR L
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2006
Last updated Sep 4th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861452112 NPPES
Arkansas MEDICAID 143678721

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