MEDICARE: MRS. DIANA CAROL HOLLINGSHEAD 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	OT-A133	AR

General Provider Information

NPI Number	:	1659589802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA CAROL HOLLINGSHEAD COTA

Provider Business Mailing Address
First Line	:	3 FINGER CIR
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72715-1626
Country	:	US
Telephone Number	:	479-621-3098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 S I ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4915
Country	:	US
Telephone Number	:	479-441-4000
Fax Number	:

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/08/2007

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