Healthcare Provider Details

I. General information

NPI: 1023665023
Provider Name (Legal Business Name): JAMES EARL BURTROM COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OAK GROVE ST
MOUNTAIN VIEW AR
72560-8601
US

IV. Provider business mailing address

2820 TIMBERLAND DR
BATESVILLE AR
72501-7837
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-5835
  • Fax:
Mailing address:
  • Phone: 479-508-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1226
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: