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General NPI Number Information
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NPI Number | 1558815837
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Entity Type | Individual
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Provider Name | STORMY ELIZABETH SLADARITZ COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 200 NW 4TH ST
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City | BRYANT
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State | AR
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Zip | 72022-3424
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Country | US
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Telephone | 501-847-5600
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Fax | 501-847-5695
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Provider Business Mailing Address
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Address Line | 3008 QUARTER HORSE LN
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City | BENTON
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State | AR
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Zip | 72015-5079
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Country | US
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Telephone | 501-303-7248
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Fax | 501-847-5695
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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-A1127
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License Number State | AR
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