Healthcare Provider Details

I. General information

NPI: 1891380796
Provider Name (Legal Business Name): LADONNA T WILLIAMS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST STE 205
LITTLE ROCK AR
72205-1579
US

IV. Provider business mailing address

102 GREENCREST DR
LITTLE ROCK AR
72204-7636
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 501-247-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1483
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: