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General NPI Number Information
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NPI Number | 1790997872
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Entity Type | Individual
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Provider Name | LEDELMA ASARIAZ COTOCO OTR
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 205 FAIRVIEW RD
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City | CROSSETT
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State | AR
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Zip | 71635-4537
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Country | US
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Telephone | 870-304-2078
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Fax | 870-864-0411
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Provider Business Mailing Address
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Address Line | 870 NICK SPRINGS RD
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City | EL DORADO
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State | AR
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Zip | 71730-9328
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Country | US
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Telephone | 870-866-5497
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR928
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License Number State | AR
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