Healthcare Provider Details

I. General information

NPI: 1164560405
Provider Name (Legal Business Name): ROBIN COPPOCK OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NW 4TH ST
BRYANT AR
72022-3424
US

IV. Provider business mailing address

9778 SPRINGHILL FARMS DR
ALEXANDER AR
72002-8998
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-5600
  • Fax:
Mailing address:
  • Phone: 501-588-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR825
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: