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General NPI Number Information
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NPI Number | 1124770060
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Entity Type | Individual
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Provider Name | MRS. AMBER ALAYNE KNUCKLES
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Gender | Female
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 408 CHERRY ST
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City | WARREN
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State | AR
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Zip | 71671-2113
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Country | US
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Telephone | 870-226-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 418 BRADLEY ROAD 31
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City | HERMITAGE
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State | AR
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Zip | 71647-9304
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Country | US
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Telephone | 870-820-2349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OT-A1763
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License Number State | AR
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