MEDICARE: CARLY WATKINS COTA/L

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	OT-A1990	AR

General Provider Information

NPI Number	:	1386419448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY WATKINS COTA/L

Provider Business Mailing Address
First Line	:	6002 W STONEY CREEK DR APT 104
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-4308
Country	:	US
Telephone Number	:	870-946-2717
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 AMERICAN ST STE B
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-6834
Country	:	US
Telephone Number	:	479-709-2002
Fax Number	:

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

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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