Healthcare Provider Details

I. General information

NPI: 1538801089
Provider Name (Legal Business Name): BAILEY TERESA RIVERS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
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

909 N SAINT JOSEPH ST
MORRILTON AR
72110-2126
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax:
Mailing address:
  • Phone: 870-224-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1813
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: