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NPI Code Detail

MEDICARE: MS. CARRIE ANN INGRAM COTA/L

MEDICARE:  MS. CARRIE ANN INGRAM  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
1224Z00000XOccupational Therapy AssistantOT-A652AR

General Provider Information

NPI Number : 1588959605
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CARRIE ANN INGRAM COTA/L
Provider Business Mailing Address
First Line : 2001 QUALITY DR APT G10
Second Line :
City : SEARCY
State : AR
Zip : 72143-8379
Country : US
Telephone Number : 870-759-1426
Fax Number :
Provider Business Practice Location Address
First Line : 130 UNDERHILL RD
Second Line :
City : BEEBE
State : AR
Zip : 72012-9751
Country : US
Telephone Number : 501-882-6660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2011
Last Update Date : 10/01/2012

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Directions to “ MS. CARRIE ANN INGRAM COTA/L” Practice Location

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