Healthcare Provider Details

I. General information

NPI: 1609217918
Provider Name (Legal Business Name): SARA KIRCHNER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 RIVER RIDGE RD
LITTLE ROCK AR
72227-1525
US

IV. Provider business mailing address

9288 MARS HILL RD
BAUXITE AR
72011-8024
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-0028
  • Fax: 501-588-3446
Mailing address:
  • Phone: 501-849-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberO-T1320
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: