Provider Demographics
NPI:1659769628
Name:ERICKSON, JO LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:LEE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:LEE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:911 PORT ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-3138
Mailing Address - Country:US
Mailing Address - Phone:870-584-8064
Mailing Address - Fax:
Practice Address - Street 1:1127 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4033
Practice Address - Country:US
Practice Address - Phone:870-584-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2783225X00000X
AR2783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist