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1124332267
JUSTIN GABRIEL PORTA
FAYETTEVILLE, AR
NPI
1124332267
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225XP0200X Occupational Therapist, Pediatrics
(Licence: AR OTR1632)
Enumeration Date
2010-07-30
Last Update Date
2010-07-30
Business Address
-- JUSTIN GABRIEL PORTA OTR/L
538 N MONROE STATION DR
FAYETTEVILLE, AR 72704-7038
Phone number: 479-466-7134
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Mailing Address
-- JUSTIN GABRIEL PORTA OTR/L
538 N MONROE STATION DR
FAYETTEVILLE, AR 72704-7038
Phone number: 479-466-7134
Copy
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