=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255756938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HASSI YORK OTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 11/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 HIGHWAY 62 E
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72576-9852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-371-0109
-----------------------------------------------------
Fax | 870-895-4440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 682
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72576-0682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-371-0109
-----------------------------------------------------
Fax | 479-474-6446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT1402
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------