Provider Demographics
NPI:1538317318
Name:JOHNSON, DANIELLE NICHOLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 FITZHUGH ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7409
Mailing Address - Country:US
Mailing Address - Phone:870-793-3334
Mailing Address - Fax:870-793-3474
Practice Address - Street 1:200 GENERAL ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9407
Practice Address - Country:US
Practice Address - Phone:870-793-3200
Practice Address - Fax:870-793-3200
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist