Healthcare Provider Details

I. General information

NPI: 1053065458
Provider Name (Legal Business Name): MORGAN NICOLE COLLINS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MORGAN NICOLE KELLY

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 SUNNY LN
NORTH LITTLE ROCK AR
72118-1285
US

IV. Provider business mailing address

4905 SUNNY LN
NORTH LITTLE ROCK AR
72118-1285
US

V. Phone/Fax

Practice location:
  • Phone: 501-804-3765
  • Fax:
Mailing address:
  • Phone: 501-804-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1834
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: