Provider Demographics
NPI:1477767283
Name:JOHNSTON, DARLA J (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:NORPHLET
Mailing Address - State:AR
Mailing Address - Zip Code:71759-0147
Mailing Address - Country:US
Mailing Address - Phone:870-546-3409
Mailing Address - Fax:
Practice Address - Street 1:485 E. MAIN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:AR
Practice Address - Zip Code:71744
Practice Address - Country:US
Practice Address - Phone:870-798-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA466224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant