Healthcare Provider Details

I. General information

NPI: 1114532553
Provider Name (Legal Business Name): RACHAEL MASTERS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHAEL SEWARD COTA/L

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 09/12/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N FULTON ST
CLARKSVILLE AR
72830-3020
US

IV. Provider business mailing address

1572 GRAVEL HILL RD
DOVER AR
72837-7857
US

V. Phone/Fax

Practice location:
  • Phone: 833-241-2847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1449
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: