Healthcare Provider Details

I. General information

NPI: 1134889926
Provider Name (Legal Business Name): BAILEY ELIZABETH VOLKMAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST STE 4
JACKSONVILLE AR
72076-4139
US

IV. Provider business mailing address

5 CHIPMUNK DR
CONWAY AR
72032-9496
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax: 501-241-0125
Mailing address:
  • Phone: 501-733-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1793
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: