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General NPI Number Information
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NPI Number | 1689176828
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Entity Type | Individual
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Provider Name | LANE ELIZABETH STANEK COTA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2018
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Last Update Date | 03/04/2018
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Provider Practice Location Address
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Address Line | 104 E BOWER AVE
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City | HARRISON
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State | AR
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Zip | 72601-3610
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Country | US
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Telephone | 479-426-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 20677 SR 124
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City | ATKINS
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State | AR
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Zip | 72823-8196
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Country | US
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Telephone | 479-518-8113
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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 |
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License Number State |
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