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General NPI Number Information
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NPI Number | 1164071999
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Entity Type | Individual
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Provider Name | LAUREN ROSE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 6815 ISAACS ORCHARD RD STE D
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City | SPRINGDALE
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State | AR
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Zip | 72762-6285
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Country | US
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Telephone | 479-856-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 COLLEGE AVE APT 117
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City | CONWAY
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State | AR
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Zip | 72034-6138
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Country | US
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Telephone | 501-581-5702
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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 | 422843
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License Number State | AR
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