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General NPI Number Information
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NPI Number | 1548064009
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Entity Type | Individual
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Provider Name | KELSEY EDWARDS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 6301 HIGHWAY 45 STE B
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City | FORT SMITH
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State | AR
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Zip | 72916-8857
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Country | US
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Telephone | 479-322-0546
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Fax |
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Provider Business Mailing Address
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Address Line | 1813 W BRYAN ST
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City | PARIS
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State | AR
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Zip | 72855-4609
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Country | US
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Telephone | 479-763-5990
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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-A2112
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License Number State | AR
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