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General NPI Number Information
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NPI Number | 1134268865
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Entity Type | Individual
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Provider Name | ANNE ROSE MCCORD COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 3998 HIGHWAY 1 N
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City | FORREST CITY
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State | AR
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Zip | 72335-7637
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Country | US
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Telephone | 870-633-1737
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Fax | 870-633-1738
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Provider Business Mailing Address
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Address Line | 503 MEREDITH DR
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City | MARION
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State | AR
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Zip | 72364-2519
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Country | US
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Telephone | 870-215-5678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OT-A364
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License Number State | AR
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