MEDICARE: SARA KIRCHNER 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
2	171W00000X	Contractor	O-T1320	AR

General Provider Information

NPI Number	:	1609217918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA KIRCHNER COTA/L

Provider Business Mailing Address
First Line	:	9288 MARS HILL RD
Second Line	:
City	:	BAUXITE
State	:	AR
Zip	:	72011-8024
Country	:	US
Telephone Number	:	501-849-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 RIVER RIDGE RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-1525
Country	:	US
Telephone Number	:	501-837-0028
Fax Number	:	501-588-3446

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

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/22/2024

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