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General NPI Number Information
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NPI Number | 1760639413
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Entity Type | Individual
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Provider Name | KEALEY LOY WYSE COTA
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Gender | Female
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 6520 BASELINE RD SUITE A
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City | LITTLE ROCK
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State | AR
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Zip | 72209-4732
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Country | US
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Telephone | 501-570-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 8724 BUCK RD
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City | ALEXANDER
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State | AR
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Zip | 72002-9506
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Country | US
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Telephone | 501-860-5775
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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 | O-T0842
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License Number State | AR
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