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NPI Code Detail

MEDICARE: MS. MICHELLE JOHN OTR/L

MEDICARE: MS. MICHELLE JOHN OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistOTR214AR

General Provider Information

NPI Number : 1417034588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE JOHN OTR/L
Provider Business Mailing Address
First Line : 2520 W MAIN ST
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-4214
Country : US
Telephone Number : 501-982-4578
Fax Number : 501-982-1253
Provider Business Practice Location Address
First Line : 2615 W MAIN ST
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-4215
Country : US
Telephone Number : 501-982-4578
Fax Number : 501-982-1253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/09/2007

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Directions to “ MS. MICHELLE JOHN OTR/L” Practice Location

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