Healthcare Provider Details

I. General information

NPI: 1174004154
Provider Name (Legal Business Name): MORGAN CECILE FOWLER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 HIGHWAY 63
RISON AR
71665-9031
US

IV. Provider business mailing address

13470 HIGHWAY 63
RISON AR
71665-8118
US

V. Phone/Fax

Practice location:
  • Phone: 870-357-8171
  • Fax:
Mailing address:
  • Phone: 870-370-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1359
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: