Healthcare Provider Details

I. General information

NPI: 1184880098
Provider Name (Legal Business Name): LAURA KIMBERLY GASKINS OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 BIRDIE DR
HORSESHOE BEND AR
72512-2864
US

IV. Provider business mailing address

138 SARA CIR
ASH FLAT AR
72513-9551
US

V. Phone/Fax

Practice location:
  • Phone: 870-291-1290
  • Fax:
Mailing address:
  • Phone: 870-291-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberO-T0814
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: