Provider Demographics
NPI:1093873531
Name:JOHNSON, JOCELYN (OTRL)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 COUNTY ROAD 133
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8084
Mailing Address - Country:US
Mailing Address - Phone:870-919-3141
Mailing Address - Fax:
Practice Address - Street 1:188 COUNTY ROAD 133
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416
Practice Address - Country:US
Practice Address - Phone:870-919-3141
Practice Address - Fax:870-931-6599
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1436225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist