MEDICARE: TABITHA TAILY TABLER COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	526581	AR

General Provider Information

NPI Number	:	1215732748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA TAILY TABLER COTA

Provider Business Mailing Address
First Line	:	185 CORNERSTONE LN
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6500
Country	:	US
Telephone Number	:	501-525-4855
Fax Number	:	501-525-5812

Provider Business Practice Location Address
First Line	:	3432 JEFFERSON AVE
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-2747
Country	:	US
Telephone Number	:	870-330-3088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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