Basic Information
| Provider Information | |||||||||
| NPI: | 1962156976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | ASHTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 HALK AVE | ||||||||
| Address2: | |||||||||
| City: | CHERRY VALLEY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723248660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702084999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3998 HIGHWAY 1 N | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723357637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706331737 | ||||||||
| FaxNumber: | 8705513724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2022 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OT-A1789 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.