Provider Demographics
NPI:1295842102
Name:JOHNSON, CHERYL R (OTR/L)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6702
Mailing Address - Country:US
Mailing Address - Phone:501-329-3661
Mailing Address - Fax:501-257-2308
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:116D
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:501-257-2308
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist