Healthcare Provider Details

I. General information

NPI: 1184880056
Provider Name (Legal Business Name): JENNIFER LYNNE RINEAR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N JAMES ST STE A
JACKSONVILLE AR
72076-3167
US

IV. Provider business mailing address

16 VIOLET LN
CABOT AR
72023-8759
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax:
Mailing address:
  • Phone: 856-816-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A526
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: