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General NPI Number Information
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NPI Number | 1659091817
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Entity Type | Individual
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Provider Name | PEDRO L TENA COTA/L
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Gender | Male
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1001 TOWSON AVE FL 6
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City | FORT SMITH
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State | AR
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Zip | 72901-4921
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Country | US
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Telephone | 479-441-3980
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 URBANA RD
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City | EL DORADO
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State | AR
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Zip | 71730-8703
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Country | US
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Telephone | 870-315-9427
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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-A1693
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License Number State | AR
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