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NPI Code Detail

MEDICARE: ANDREA ROGERS VANHECKE COTA

MEDICARE: ANDREA ROGERS VANHECKE 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
1252Y00000XEarly Intervention Provider AgencyOTA-394AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OTA-394OTHERARAR STATE MEDICAL BOARD

General Provider Information

NPI Number : 1548663719
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA ROGERS VANHECKE COTA
Provider Business Mailing Address
First Line : 3400 N WOODS LN
Second Line :
City : ROGERS
State : AR
Zip : 72756-6712
Country : US
Telephone Number : 479-636-3190
Fax Number :
Provider Business Practice Location Address
First Line : 3400 N WOODS LN
Second Line :
City : ROGERS
State : AR
Zip : 72756-6712
Country : US
Telephone Number : 479-636-3190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2014
Last Update Date : 10/02/2014

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