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General NPI Number Information
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NPI Number | 1730837964
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Entity Type | Individual
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Provider Name | ASHLEY FAITH MENDEZ COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 916 E GUM ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-8181
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Country | US
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Telephone | 479-831-5092
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Fax |
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Provider Business Mailing Address
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Address Line | 916 E GUM ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-8181
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Country | US
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Telephone | 479-831-5092
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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-A1807
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License Number State | AR
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