MEDICARE: LESLIE MARIE BAKER COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OT-A704	AR

General Provider Information

NPI Number	:	1538410840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MARIE BAKER COTA/L

Provider Business Mailing Address
First Line	:	219 CHANTILLY AVE
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-7532
Country	:	US
Telephone Number	:	479-502-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 SOUTHWINDS RD STE 2
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-8652
Country	:	US
Telephone Number	:	479-631-7678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	02/10/2020

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