Healthcare Provider Details

I. General information

NPI: 1821906355
Provider Name (Legal Business Name): BROOKE HAYES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 CUMBERLAND ST
LITTLE ROCK AR
72202-5061
US

IV. Provider business mailing address

217 JOHNSON ST
LITTLE ROCK AR
72205-5823
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-1788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A2239
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: