MEDICARE: SAMANTHA RENEE SARNA 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

General Provider Information

NPI Number	:	1609507631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RENEE SARNA COTA/L

Provider Business Mailing Address
First Line	:	2520 WEST MAIN STREET
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076
Country	:	US
Telephone Number	:	501-982-0528
Fax Number	:	501-533-6326

Provider Business Practice Location Address
First Line	:	2400 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4212
Country	:	US
Telephone Number	:	501-982-4578
Fax Number	:	501-533-6326

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/05/2023

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