Healthcare Provider Details

I. General information

NPI: 1558729236
Provider Name (Legal Business Name): REGAN COTTER ECDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 E. MAIN
MELBOURNE AR
72556
US

IV. Provider business mailing address

63 LIBERTY HILL CIR
HIGHLAND AR
72542-9004
US

V. Phone/Fax

Practice location:
  • Phone: 870-368-4586
  • Fax: 870-368-4587
Mailing address:
  • Phone: 870-710-1336
  • Fax: 870-368-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: