MEDICARE: LINDSEY NICOLE HUCKABY 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	OT-A1795	AR

General Provider Information

NPI Number	:	1851009302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY NICOLE HUCKABY COTA/L

Provider Business Mailing Address
First Line	:	323 BRAD RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9725
Country	:	US
Telephone Number	:	501-747-3231
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 VILLAGE DR
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72019-9466
Country	:	US
Telephone Number	:	501-943-7208
Fax Number	:

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

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	02/02/2024

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