Healthcare Provider Details

I. General information

NPI: 1073930756
Provider Name (Legal Business Name): JENNIE L. FICKLER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 COUNTRY CLUB RD
SHERWOOD AR
72120-5095
US

IV. Provider business mailing address

1540 COUNTRY CLUB RD
SHERWOOD AR
72120-5095
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-5459
  • Fax:
Mailing address:
  • Phone: 501-753-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A2131
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: