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General NPI Number Information
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NPI Number | 1508224593
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Entity Type | Individual
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Provider Name | JUSTIN NEIL CARTER COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 615 MOUNTAIN VIEW RD
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City | GLENWOOD
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State | AR
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Zip | 71943-9061
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Country | US
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Telephone | 870-356-3953
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Fax |
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Provider Business Mailing Address
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Address Line | 240 MATTHEWS DR G102
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City | HOT SPRINGS
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State | AR
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Zip | 71901-9614
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Country | US
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Telephone | 870-500-5158
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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-A728
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License Number State | AR
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