Healthcare Provider Details

I. General information

NPI: 1801646617
Provider Name (Legal Business Name): CHERYL ANNE BECKWITH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 S PLEASANT CROSSING BLVD
ROGERS AR
72758-1347
US

IV. Provider business mailing address

4847 W BRUSH CREEK LOOP
ROGERS AR
72756-9230
US

V. Phone/Fax

Practice location:
  • Phone: 479-341-4003
  • Fax:
Mailing address:
  • Phone: 808-895-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A1539
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: