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General NPI Number Information
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NPI Number | 1730540303
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Entity Type | Individual
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Provider Name | AMANDA MARIE PETERS COTA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 2319 E MATTHEWS AVE
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City | JONESBORO
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State | AR
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Zip | 72401-4415
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Country | US
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Telephone | 870-919-0274
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Fax | 870-277-4335
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Provider Business Mailing Address
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Address Line | 771 SUNNY VALLEY LN
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-6627
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Country | US
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Telephone | 573-429-8203
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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-A985
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2015002804
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License Number State | MO
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