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General NPI Number Information
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NPI Number | 1386149573
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Entity Type | Individual
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Provider Name | TIANNA ANNMARIE PARSON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 1000 W BUCHANAN ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830
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Country | US
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Telephone | 479-754-6210
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 DURANGO DR
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City | VAN BUREN
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State | AR
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Zip | 72956
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Country | US
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Telephone | 479-208-1941
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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-A1351
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License Number State | AR
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