=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164671822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN SUZANNE GRUMBINE THRASH COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2008
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1609 PINE ST
-----------------------------------------------------
City | ARKADELPHIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71923-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-636-0078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 NW FRONT ST
-----------------------------------------------------
City | ASHDOWN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71822-8753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-636-0078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OT-A402
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------