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General NPI Number Information
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NPI Number | 1669868899
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Entity Type | Individual
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Provider Name | AMANDA DICKERSON COTA/L
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Gender | Female
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 8390 US 49 NORTH
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City | BROOKLAND
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State | AR
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Zip | 72417
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Country | US
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Telephone | 870-932-1205
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Fax |
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Provider Business Mailing Address
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Address Line | 802 REDWOOD DR
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City | PARAGOULD
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State | AR
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Zip | 72450-5541
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Country | US
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Telephone |
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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-A947
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License Number State | AR
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