Healthcare Provider Details

I. General information

NPI: 1073142246
Provider Name (Legal Business Name): CHRISTINA M FLIEGER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 BATESVILLE MOUNTAIN RD
DAMASCUS AR
72039-8132
US

IV. Provider business mailing address

375 BATESVILLE MOUNTAIN RD
DAMASCUS AR
72039-8132
US

V. Phone/Fax

Practice location:
  • Phone: 940-367-6313
  • Fax:
Mailing address:
  • Phone: 940-367-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-112785
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1914
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: