Healthcare Provider Details

I. General information

NPI: 1124724620
Provider Name (Legal Business Name): CHRISTINA GERBINE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SCHOOL DR
MELBOURNE AR
72556-8620
US

IV. Provider business mailing address

31 SCHOOL DR
MELBOURNE AR
72556-8620
US

V. Phone/Fax

Practice location:
  • Phone: 870-544-4045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1897
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: