=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447864103
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANA S SIMS COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2020
-----------------------------------------------------
Last Update Date | 02/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 N PRICKETT RD STE 2
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-7511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-213-0594
-----------------------------------------------------
Fax | 844-272-0941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1419
-----------------------------------------------------
City | ALEXANDER
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72002-3419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-258-3122
-----------------------------------------------------
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 | OTA1572
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------