Justin Gabriel Porta, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OTR1632 Issued in AR

Practice address

538 N Monroe Station Dr
Fayetteville, AR 72704-7038

Phone

(479) 466-7134

NPI assigned

Jul 30, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280448000000",
    "number": "1124332267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N MONROE STATION DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047038",
            "telephone_number": "479-466-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 N MONROE STATION DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047038",
            "telephone_number": "479-466-7134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTA",
        "first_name": "JUSTIN",
        "middle_name": "GABRIEL",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-30",
        "last_updated": "2010-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "AR",
            "license": "OTR1632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcelina Pop
• Annmarie Pope, M.ED
• Dorothy Ann Pope, APN
• Dustin Lee Pope, OT
• Kevin L Pope, MD
• William Porter, DDS
• Hayley Portmann
• Cathrine Post, DC
• Amanda Potter, APRN, FNP-C
• Genna Potter, MD

• Pediatric Occupational Therapist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Pediatric Occupational Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.