MEDICARE: HANNAH ELIZABETH KING 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	4755	CA
2	224Z00000X	Occupational Therapy Assistant	1065	AR

General Provider Information

NPI Number	:	1609336437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH ELIZABETH KING COTA

Provider Business Mailing Address
First Line	:	2002 WOODWIND WAY
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-6410
Country	:	US
Telephone Number	:	479-358-3090
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3148
Country	:	US
Telephone Number	:	479-452-1541
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	03/20/2019

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