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NPI Code Detail

MEDICARE: JUSTICE THOMPSON COTA

MEDICARE: JUSTICE THOMPSON 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
1224Z00000XOccupational Therapy Assistant1877AR

General Provider Information

NPI Number : 1396461984
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTICE THOMPSON COTA
Provider Business Mailing Address
First Line : 311 LEXINGTON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-3842
Country : US
Telephone Number : 501-912-2224
Fax Number :
Provider Business Practice Location Address
First Line : 311 LEXINGTON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-3842
Country : US
Telephone Number : 501-912-2224
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2022
Last Update Date : 10/14/2022

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